Bruins P, te Velthuis H, Yazdanbakhsh A P, Jansen P G, van Hardevelt F W, de Beaumont E M, Wildevuur C R, Eijsman L, Trouwborst A, Hack C E
Department of Anaesthesiology, Academic Medical Centre, Amsterdam, The Netherlands.
Circulation. 1997 Nov 18;96(10):3542-8. doi: 10.1161/01.cir.96.10.3542.
Complement activation during cardiopulmonary bypass (CPB) surgery is considered to result from interaction of blood with the extracorporeal circuit. We investigated whether additional mechanisms may contribute to complement activation during and after CPB and, in particular, focused on a possible role of the acute-phase protein C-reactive protein (CRP).
In 19 patients enrolled for myocardial revascularization, perioperative and postoperative levels of complement activation products, interleukin-6 (IL-6), CRP, and complement-CRP complexes, reflecting CRP-mediated complement activation in vivo, were measured and related to clinical symptoms. A biphasic activation of complement was observed. The ratio between the areas under the curve of perioperative and postoperative C3b/c and C4b/c were 3:2 and 1:46, respectively. IL-6 levels reached a maximum at 6 hours post-surgery. CRP levels peaked on the second postoperative day. Each complement-CRP complex had peak levels on the second or third postoperative day. By multivariate analysis, maximum levels of CRP on the second postoperative day were mainly explained by C4b/c levels after protamine administration, leukocyte count on the second postoperative day, and preoperative levels of CRP. Peak levels of C4b/c after protamine administration (P=.0073) and on the second postoperative day correlated with the occurrence of arrhythmia on the same day (P=.0065).
Cardiac surgery with CPB causes a biphasic complement activation. The first phase occurs during CPB and results from the interaction of blood with the extracorporeal circuit. The second phase, which occurs during the first 5 days after surgery, involves CRP, is related to baseline CRP levels, and is associated with clinical symptoms such as arrhythmia.
体外循环（CPB）手术期间的补体激活被认为是血液与体外循环回路相互作用的结果。我们研究了是否有其他机制可能导致CPB期间及之后的补体激活，尤其关注急性期蛋白C反应蛋白（CRP）的可能作用。
对19例接受心肌血运重建的患者，测量围手术期和术后补体激活产物、白细胞介素-6（IL-6）、CRP及补体-CRP复合物的水平，这些指标反映体内CRP介导的补体激活，并将其与临床症状相关联。观察到补体呈双相激活。围手术期和术后C3b/c及C4b/c曲线下面积之比分别为3:2和1:46。IL-6水平在术后6小时达到峰值。CRP水平在术后第二天达到高峰。每种补体-CRP复合物在术后第二天或第三天达到峰值水平。通过多变量分析，术后第二天CRP的最高水平主要由鱼精蛋白给药后的C4b/c水平、术后第二天的白细胞计数及术前CRP水平所解释。鱼精蛋白给药后（P = 0.0073）及术后第二天C4b/c的峰值水平与同一天心律失常的发生相关（P = 0.0065）。
CPB心脏手术导致补体双相激活。第一阶段发生在CPB期间，是血液与体外循环回路相互作用的结果。第二阶段发生在术后头5天内，涉及CRP，与基线CRP水平相关，并与心律失常等临床症状有关。
