Boldt J, Kumle B, Papsdorf M, Hempelmann G
Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
Ann Thorac Surg. 1998 Mar;65(3):608-14. doi: 10.1016/s0003-4975(97)01306-4.
Soluble adhesion molecules are considered to be markers of inflammation, endothelial activation, or damage. This study was designed to assess whether adhesion molecules are specifically altered in patients undergoing cardiac surgical procedures.
Three groups of 20 patients each were prospectively studied: patients undergoing elective coronary artery bypass grafting; patients scheduled for a Whipple pancreatoduodenectomy; and patients undergoing elective pneumonectomy for lung cancer. Plasma levels of soluble adhesion molecules (endothelial leukocyte adhesion molecule-1, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and granule membrane protein 140) were measured from arterial blood samples after induction of anesthesia (baseline), at the end of the operation, 2 hours and 5 hours after operation, and on the morning of the first postoperative day.
Duration of operation was longest in the group having a Whipple operation (289 +/- 50 minutes) and did not differ between the other two groups. Plasma levels of all measured adhesion molecules at baseline were within normal ranges. After cardiopulmonary bypass, levels of adhesion molecules were significantly increased in the cardiac surgical patients (soluble endothelial leukocyte adhesion molecule-1, from 38 +/- 11 ng/mL at baseline to 68 +/- 12 ng/mL; soluble intercellular adhesion molecule-1, from 241 +/- 50 ng/mL to 498 +/- 78 ng/mL; and granule membrane protein 140, from 69 +/- 12 ng/mL to 150 +/- 25 ng/mL). On the morning of the first postoperative day, all levels had returned to baseline except that of soluble vascular cell adhesion molecule-1, which was still elevated (p < 0.05). In both the other groups, concentrations of adhesion molecules remained almost unchanged.
Cardiac operation was associated with increased plasma levels of soluble adhesion molecules, a finding indicating endothelial activation or dysfunction. In contrast, in patients undergoing complex, long-lasting abdominal or lung operations, soluble adhesion molecules remained unchanged. Activation of proinflammatory cascades, ischemia/reperfusion phenomenon, and microcirculatory dysfunction appear to be the most likely reasons for this difference between groups. Whether modulation of adhesion molecules may influence organ function after cardiopulmonary bypass remains to be elucidated in further studies.
可溶性黏附分子被认为是炎症、内皮细胞活化或损伤的标志物。本研究旨在评估接受心脏手术的患者体内黏附分子是否有特异性改变。
前瞻性研究了三组患者，每组20例：接受择期冠状动脉搭桥术的患者；计划进行惠普尔胰十二指肠切除术的患者；以及因肺癌接受择期肺切除术的患者。在麻醉诱导后（基线）、手术结束时、术后2小时和5小时以及术后第一天早晨，从动脉血样本中测量可溶性黏附分子（内皮白细胞黏附分子-1、细胞间黏附分子-1、血管细胞黏附分子-1和颗粒膜蛋白140）的血浆水平。
接受惠普尔手术的组手术持续时间最长（289±50分钟），其他两组之间无差异。所有测量的黏附分子在基线时的血浆水平均在正常范围内。体外循环后，心脏手术患者体内黏附分子水平显著升高（可溶性内皮白细胞黏附分子-1，从基线时的38±11 ng/mL升至68±12 ng/mL；可溶性细胞间黏附分子-1，从241±50 ng/mL升至498±78 ng/mL；颗粒膜蛋白140，从69±12 ng/mL升至150±25 ng/mL）。在术后第一天早晨，除可溶性血管细胞黏附分子-1水平仍升高外（p<0.05），所有水平均恢复至基线。在其他两组中，黏附分子浓度几乎保持不变。
心脏手术与可溶性黏附分子血浆水平升高有关，这一发现表明内皮细胞活化或功能障碍。相比之下，在接受复杂、持久的腹部或肺部手术的患者中，可溶性黏附分子保持不变。促炎级联反应的激活、缺血/再灌注现象和微循环功能障碍似乎是两组之间存在这种差异的最可能原因。黏附分子的调节是否会影响体外循环后的器官功能仍有待进一步研究阐明。
