Menasché P, Peynet J, Le Deist F, Carreno M P, Haeffner-Cavaillon N, Dillisse V, Larivière J, Piwnica A, Bloch G, Tedgui A
Service de chirurgie cardiovasculaire, hôpital Lariboisière, Paris.
Arch Mal Coeur Vaiss. 1995 Oct;88(10):1415-23.
The increasing interest in "warm" aerobic cardioplegia requires a critical reevaluation of the systemic effects of the associated normothermic cardiopulmonary bypass (CPB). As activated neutrophils seem to be essential mediators of the inflammatory response to CPB via the cytotoxicity of the products that are released during their adhesion to endothelial cells, the authors undertook a study of the influence of temperature on the interaction between the neutrophils and the endothelium in 95 patients undergoing warm (31-33.5 degrees C, n = 49) and cold (26-27 degrees C, n = 46) CPB surgery. Blood sampling was performed before, during and after CPB. The following markers of neutrophil-endocardium interaction were analysed: complement activation (C3a), cytokine production (tumor necrosis factor alpha, interleukines 1, 6 and 8, and interleukin-1 receptor antagonist); endothelial expression of cytokine-dependent [intercellular adhesion molecule (ICAM)] and cytokine-independent (P-selectin) adhesion molecules (P-selectin); expression of cytokine molecules on the surface of polynuclear neutrophils (CD11a, CD11b, CD11c); and finally, endothelial adhesion and transendothelial migration of neutrophils (interleukin 8 and elastase). The results showed that, irrespective of temperature, CPB was associated with changes strongly suggestive of phenomena of transendothelial adhesion and migration. Moreover, normothermia increased the intensity of the inflammatory response as shown by increased cytokine production, earlier expression of neutrophil adhesion molecules and increased elastase production.
对“温血”有氧心脏停搏液的兴趣与日俱增，这就需要对相关常温体外循环（CPB）的全身效应进行严格的重新评估。由于活化的中性粒细胞似乎是CPB炎症反应的关键介质，其通过在黏附于内皮细胞过程中释放的产物的细胞毒性作用发挥作用，因此作者对95例接受常温（31 - 33.5摄氏度，n = 49）和低温（26 - 27摄氏度，n = 46）CPB手术患者的中性粒细胞与内皮细胞之间相互作用的温度影响进行了研究。在CPB前、中、后进行血样采集。分析了以下中性粒细胞与心内膜相互作用的标志物：补体激活（C3a）、细胞因子产生（肿瘤坏死因子α、白细胞介素1、6和8以及白细胞介素-1受体拮抗剂）；细胞因子依赖性[细胞间黏附分子（ICAM）]和细胞因子非依赖性（P-选择素）黏附分子（P-选择素）的内皮表达；多核中性粒细胞表面细胞因子分子的表达（CD11a、CD11b、CD11c）；最后是中性粒细胞的内皮黏附和跨内皮迁移（白细胞介素8和弹性蛋白酶）。结果表明，无论温度如何，CPB都与强烈提示跨内皮黏附和迁移现象的变化相关。此外，常温增加了炎症反应的强度，表现为细胞因子产生增加、中性粒细胞黏附分子表达提前以及弹性蛋白酶产生增加。
