COMPLEMENT ACTIVATION DURING CARDIOPULMONARY BYPASS - EVIDENCE FOR GENERATION OF C3A AND C5A ANAPHYLATOXINS
COMPLEMENT ACTIVATION DURING CARDIOPULMONARY BYPASS - EVIDENCE FOR GENERATION OF C3A AND C5A ANAPHYLATOXINS
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DOI：
10.1056/nejm198102263040901
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发表时间：
1981-01-01
影响因子：
158.5
通讯作者：
KIRKLIN, JW
中科院分区：
文献类型：
--
作者：
CHENOWETH, DE;COOPER, SW;KIRKLIN, JW
在 15 名接受全体外循环的成人中观察到补体 [c] 激活。手术开始时，C3a 的血浆水平显着升高 (P < 0.0001)；此后，它们继续稳步增长。手术结束时，C3a 水平比术前水平高出 5 倍以上。 C5a（一种与中性粒细胞密切结合的因子）的血浆水平在体外循环期间没有显着变化。搭桥期间有显着的中性粒细胞增多（P = 0.03）；当部分搭桥重建心肺循环时，会发生显着的经肺中性粒细胞减少症（P = 0.0002）。中性粒细胞减少症与 C5a 激活粒细胞的肺血管隔离一致。用气泡氧合器的尼龙网衬里孵育血液，以及全血的剧烈氧合，显然促进了 C 的转化。体外循环过程中产生的 C 衍生炎症介质 C3a 和 C5a 显然可能有助于泵后综合征的发病机制。
Complement [c] activation in 15 [human] adults undergoing total cardiopulmonary bypass was observed. Plasma levels of C3a were significantly elevated (P < 0.0001) at the beginning of the procedure; they continued to increase steadily thereafter. At the end of the procedure, C3a levels were more than 5 times higher than preoperative levels. Plasma levels of C5a (a factor that binds avidly to neutrophils) did not change significantly during cardiopulmonary bypass. There was significant neutrophilia (P = 0.03) during bypass; significant transpulmonary neutropenia (P = 0.0002) occurred when cardiopulmonary ciruclation was reestablished at partial bypass. The neutropenia is consistent with pulmonary-vascular sequestration of C5a-activated granulocytes. Incubation of blood with the nylon-mesh liner of bubble oxygenators, and vigorous oxygenation of whole blood, apparently promotes conversion of C. The C-derived inflammatory mediators C3a and C5a produced during extracorporeal circulation apparently may contribute to the pathogenesis of post-pump syndromes.