CD62L (L-Selectin) Shedding for Assessment of Perioperative Immune Sensitivity in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass
CD62L (L-Selectin) Shedding for Assessment of Perioperative Immune Sensitivity in Patients Undergoing Cardiac Surgery with Cardiopulmonary Bypass
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DOI：
10.1371/journal.pone.0053045
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发表时间：
2013-01-03
期刊：
影响因子：
3.7
通讯作者：
Book, Malte
中科院分区：
文献类型：
--
作者：
Erdoes, Gabor;Balmer, Maria L.;Book, Malte
目的：评价体外循环心脏手术患者围术期免疫功能的变化，以不同激动剂诱导CD62L脱落所需的数量为指标，探讨外周血粒细胞和单核细胞敏感性作为评价围术期免疫变化的适宜性。分别于麻醉诱导前、手术后即刻和麻醉诱导后48h采血。我们测定了两种不同的炎性刺激--脂磷壁酸(LTA)和肿瘤坏死因子-α(TNF)--诱导50%的CD62L从血粒细胞和单核细胞脱落所需的浓度。并行单核细胞表面人类白细胞抗原-DR和血浆白介素8、可溶性(S)CD62L、可溶性(S)TLR2和ADAM17定量检测，说明围手术期的免疫调节作用。术后即刻外周血粒细胞和单核细胞对TLR2/6激动剂金黄色葡萄球菌LTA的敏感性降低(p=0.001和p=0.004)。相反，粒细胞(p=0.057)，而不是单核细胞(p=0.057)术后对肿瘤坏死因子的敏感性降低。我们通过测量围手术期血浆IL-8浓度的显著升高，证实了手术后存在全身炎症反应和免疫敏感性降低(P
Objective: To investigate the suitability of blood granulocyte and monocyte sensitivity, as measured by the quantity of different agonists required to induce CD62L shedding, for assessment of perioperative immune changes in patients undergoing cardiac surgery with cardiopulmonary bypass.Methods: Patients scheduled for aortocoronary bypass grafting or for valve surgery were included in this prospective observational study. Blood samples were drawn before anesthesia induction, directly after surgery and 48 hours after anesthesia induction. We determined the concentration of two different inflammatory stimuli - lipoteichoic acid (LTA) and tumor necrosis factor alpha (TNF) - required to induce shedding of 50% of surface CD62L from blood granulocytes and monocytes. In parallel monocyte surface human leukocyte antigen (HLA)-DR, and plasma interleukin (IL)-8, soluble (s)CD62L, soluble (s)Toll-like receptor (TLR)-2 and ADAM17 quantification were used to illustrate perioperative immunomodulation.Results: 25 patients were enrolled. Blood granulocytes and monocytes showed decreased sensitivity to the TLR 2/6 agonist Staphylococcus aureus LTA immediately after surgery (p = 0.001 and p = 0.004 respectively). In contrast, granulocytes (p = 0.01), but not monocytes (p = 0.057) displayed a decreased postoperative sensitivity to TNF. We confirmed the presence of a systemic inflammatory response and a decreased immune sensitivity in the post-surgical period by measuring significant increases in the perioperative plasma concentration of IL-8 (p