Groeneveld A B, Raijmakers P G, Rauwerda J A, Hack C E
Department of Internal Medicine, Free University Hospital, Amsterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 1997 Nov;14(5):351-9. doi: 10.1016/s1078-5884(97)80284-5.
To characterise the inflammatory response to vascular surgery and ischaemia/reperfusion (I/R) in man, regarding release of inflammatory mediators, recruitment and activation of neutrophils, and their relation to postoperative pulmonary function.
Prospective cohort study.
Circulating neutrophil counts and plasma levels of elastase-alpha 1-antitrypsin (AT), a neutrophil degranulation product, were measured before and approx. 2.5 h (group 1, n = 19) after elective abdominal aortic surgery, and approx. 2.9 h after elective peripheral vascular surgery (group 2, n = 6), together with concentrations of neutrophil agonists, including activated complement (C3a), secretory phospholipase A2 (sPLA2), tumor necrosis factor (TNF-alpha), interleukin (IL)-6, IL-8 and granulocyte colony-stimulating factor (G-CSF). At the time of blood sampling, respiratory variables allowing computation of the lung injury score (LIS) were obtained in patients admitted after surgery in the intensive care unit (ICU), i.e. all group 1 patients and one group 2 patient.
Median (range) neutrophil counts rose by 80% (-28-208) and 90% (10-147) in groups 1 and 2, respectively (n.s. between groups). The increase (p < 0.05) in elastase-alpha 1-AT level was 121% (-5-439) in group 1 and 82% (18-792) in group 2 (n.s. between groups). There was a rise (p < 0.05) in C3a level by 93% (-42-751) and of sPLA2 level by 68% (-40-1400) after surgery for the groups together (n.s. between groups), and the rise of the elastase-alpha 1-AT related to that of the C3a levels. IL-6 and G-CSF concentrations increased more in group 1 than 2. The IL-8 concentration increased in group 1 only, and TNF-alpha was unchanged in all groups. In ICU patients, the LIS related to the postoperative rise in IL-6 level only, even though the rise in plasma concentrations of cytokines interrelated. No patient developed ARDS and all survived.
Vascular surgery and I/R in man activates complement, releases cytokines (except for TNF-alpha), and induces neutrophil recruitment and degranulation, which may primarily depend on complement activation. In contrast to the latter, the release of cytokines may depend on the extent of I/R and may contribute to transient pulmonary dysfunction after extensive I/R.
通过研究炎症介质的释放、中性粒细胞的募集和激活及其与术后肺功能的关系，来描述人体对血管手术及缺血/再灌注（I/R）的炎症反应。
前瞻性队列研究。
在择期腹主动脉手术后约2.5小时（第1组，n = 19）以及择期外周血管手术后约2.9小时（第2组，n = 6），分别测量循环中性粒细胞计数以及中性粒细胞脱颗粒产物弹性蛋白酶-α1抗胰蛋白酶（AT）的血浆水平，同时测量中性粒细胞激动剂的浓度，包括活化补体（C3a）、分泌型磷脂酶A2（sPLA2）、肿瘤坏死因子（TNF-α）、白细胞介素（IL）-6、IL-8和粒细胞集落刺激因子（G-CSF）。在采血时，对入住重症监护病房（ICU）的手术后患者（即所有第1组患者和1例第2组患者）获取可用于计算肺损伤评分（LIS）的呼吸变量。
第1组和第2组的中性粒细胞计数中位数（范围）分别升高了80%（-28 - 208）和90%（10 - 147）（两组间无显著差异）。第1组弹性蛋白酶-α1抗胰蛋白酶水平升高（p < 0.05）121%（-5 - 439），第2组升高82%（18 - 792）（两组间无显著差异）。两组手术后C3a水平升高（p < 0.05）93%（-42 - 751），sPLA2水平升高68%（-40 - 1400）（两组间无显著差异），且弹性蛋白酶-α1抗胰蛋白酶的升高与C3a水平的升高相关。IL-6和G-CSF浓度在第1组比第2组升高得更多。IL-8浓度仅在第1组升高，而TNF-α在所有组均未变化。在ICU患者中，LIS仅与术后IL-6水平的升高相关，尽管细胞因子血浆浓度的升高相互关联。没有患者发生急性呼吸窘迫综合征（ARDS），所有患者均存活。
人体的血管手术及I/R激活补体，释放细胞因子（TNF-α除外），并诱导中性粒细胞募集和脱颗粒，这可能主要依赖于补体激活。与后者不同，细胞因子的释放可能取决于I/R的程度，并可能导致广泛I/R后短暂的肺功能障碍。
