【摘要】 为了解体外循环期间瓣膜替换手术患者白细胞、内皮细胞表面粘附分子的表达及这些粘附分子表达水平之间的关系，测定了１２例患者体外循环前后外周血白细胞β２粘合素（β２－ｉｎｔｅｇｒｉｎｓ）、血浆可溶性细胞间粘附分子－１（ｓｏｌｕｂｅｉｎｔｅｒｃｅｌｕｌａｒａｄｈｅｓｉｏｎｍｏｌｅｃｕｌｅ－１，ｓＩＣＡＭ－１），和可溶性Ｅ－选择素（ｓｏｌｕｂｌｅＥ－ｓｅｌｅｃｔｉｎ，ｓＥ－ｓｅｌｅｃｔｉｎ）。结果：体外循环后β２－ｉｎｔｅｇｒｉｎｓ（ＣＤ１１ａ、ＣＤ１８、ＣＤ１１ａ／ＣＤ１８，ＣＤ１１ｂ，ＣＤ１１ｂ／ＣＤ１８），ｓＩＣＡＭ－１和ｓＥ－ｓｅｌｅｃｔｉｎ表达上调（Ｐ＜０．０５）；β２－ｉｎｔｅｇｒｉｎｓ和ｓＩＣＡＭ－１、ｓＥ－ｓｅｌｅｃｔｉｎ表达水平之间存在明显的相关关系（Ｐ＜０．００５）。结果显示：①体外循环伴随着明显的白细胞－内皮细胞粘附反应；②体外循环期间有关的粘附分子以受体－配体形式表达；③血浆可溶性内皮细胞粘附分子ｓＩＣＡＭ－１、ｓＥ－ｓｅｌｅｃｔｉｎ可间接估计内皮细胞表面ＩＣＡＭ－１、Ｅ－ｓｅｌｅｃｔｉｎ表达情况更多还原

【Abstract】 The objectives of this study were to measure leukocyte adhesion molecule expression, assess the possibility of evaluating the serum levels of the soluble form of endothelium adhesion molecule as an alternative for endothelia cell activation. and analyze the correlation and regression between leukocyte adhesion molecule expression and soluble endothelium adhesion molecule levels during cardiopulmonary bypass (CPB) in patients undergoing valve replacement. Twelve adult patients were included in this study. The extracorporeal circuit was primed with Ringer’s lactate. After systemic heparinization (300IU/kg), CPB was initiated with a bubble oxygenator.Patients were cooled to about 28℃,at that temperature, aorta was clamped and cold crystalloid cardioplegia was delivered into aortic root.The activatal clotting time was maintained at greater than 450 seconds. 1 1.3 mg of protamine was administered for each 100 IU of heparin given prior to CPB. Peripheral blood was collected at the day prior to surgery and the morning of postoperative days 1,2,5, and 7 for determination of the expression of leukocyte CD 11a , CD 18 ,CD 11a /CD 18 ,CD 11b ,CD 11b /CD 18 (immunofluorescent flow cytometry) and the plasma soluble intercellular adhesion molecule 1(sICAM 1), soluble E selectin (sE selectin) (enzyme linked immunoabsorbent assay). CPB caused a sustained increase in the leukocyte CD 11a , CD 18 ,CD 11a /CD 18 ,CD 11b /CD 18 expression and the plasma sICAM 1, sE selectin levels in patients ( P<0.05 ). Up regulation of the leukocyte adhesion molecule expression and increase of the circulation endothelium adhesion molecule levels lasted at least 2 days after surgery ( P<0.05 ) except CD 11a .There were correlation and regression between leukocyte adhesion molecule expression and soluble endothelium adhesion molecule levles ( r =0.91 0.99, P =0.0322 0 0005; =-1377.06-44 64+1 49-14 78a to =44 64+1 49a) These results suggest that CPB causes obvious leukocyte endothelia interactions, that the expression of these adhesion molecules are presented by means of receptor ligand form, and that the measurement of sICAM 1 and sE selectin may well be used as a marker of endothelial cell activation.更多还原