Chello M, Mastroroberto P, Cirillo F, Bevacqua E, Carrano A, Perticone F, Marchese A R
Department of Experimental and Clinical Medicine, Medical School of Catanzaro, Italy.
Eur J Cardiothorac Surg. 1998 Oct;14(4):373-9. doi: 10.1016/s1010-7940(98)00222-x.
Diabetes mellitus is a well-known risk factor in patients undergoing coronary artery bypass grafting. Myocardial and pulmonary injury often occurs after cardiopulmonary bypass (CPB), mediated in part by neutrophil activation and adhesion to endothelial cells. The objectives of the present study are to compare the degree of neutrophil activation and neutrophil-endothelial cells adhesive interactions in diabetic patients after CPB.
Nitro-blu tetrazolium scores, CD 11b expression and neutrophil-endothelial cells adhesion were assessed in blood samples from 15 diabetic and 15 control patients who had undergone elective coronary bypass grafting. Blood samples were obtained at baseline, 30 min after beginning CPB, at the end of CPB and 60 min postoperatively. At the same sampling points as above, blood glucose levels were also checked in all patients.
Diabetes was associated with a significant basal increase in neutrophil CD1 lb expression and adhesion to endothelial cells as well as with an increased superoxide anion production. The increased adhesion of diabetic neutrophils persisted by the end of the CPB to 60 min postoperatively independently of the blood glucose levels. Antibodies directed against CD1 lb and CD18 significantly reduced the degree of neutrophil adhesion observed 60 min postoperatively.
These results indicate that diabetes mellitus is associated with an increased neutrophil-endothelial cell adhesion probably mediated by the CD1 1b/CD18 molecule; this, in turn, might be responsible for the increased risk of postoperative complications observed in diabetic patients undergoing coronary artery bypass grafting.
糖尿病是接受冠状动脉搭桥手术患者的一个众所周知的危险因素。体外循环（CPB）后常发生心肌和肺损伤，部分由中性粒细胞激活以及与内皮细胞的黏附介导。本研究的目的是比较CPB后糖尿病患者中性粒细胞激活程度以及中性粒细胞与内皮细胞的黏附相互作用。
对15例接受择期冠状动脉搭桥手术的糖尿病患者和15例对照患者的血样进行硝基蓝四唑评分、CD11b表达及中性粒细胞与内皮细胞黏附的评估。在基线、CPB开始后30分钟、CPB结束时及术后60分钟采集血样。在上述相同采样点，还对所有患者检查血糖水平。
糖尿病与中性粒细胞CD11b表达及与内皮细胞黏附的基础显著增加以及超氧阴离子生成增加有关。糖尿病患者中性粒细胞黏附增加在CPB结束时持续至术后60分钟，且与血糖水平无关。针对CD11b和CD18的抗体显著降低了术后60分钟观察到的中性粒细胞黏附程度。
这些结果表明，糖尿病与中性粒细胞 - 内皮细胞黏附增加有关，可能由CD11b/CD18分子介导；这反过来可能是接受冠状动脉搭桥手术的糖尿病患者术后并发症风险增加的原因。
