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目的 研究补体 4基因多态性与体外循环中补体系统激活程度和肺功能障碍之间的关系。方法 选择武汉市及周边地区在体外循环 (CPB)下进行心脏直视手术的患儿 15 6例 ,于术前抽血用交叉免疫电泳法进行补体 4基因型分析。分别于CPB开始前、CPB结束时以及鱼精蛋白中和肝素后 10min抽取动脉血样 ,以放免法对补体 3和 4活化产物C3a和C4a进行测定 ,同时记录肺顺应性。结果 补体 4基因型AABB、AOBB、OOBB、AABO及AAOO出现频率分别为 5 1.2 8%、17.95 %、4.49%、19 87%及 6 .41%。CPB结束时C4a水平无明显升高 ,C3a水平显著升高。鱼精蛋白中和肝素后 10min时C4a和C3a水平显著升高 ,以OOBB组升高最显著 ,其次为AOBB组 ;同时OOBB组肺顺应性下降最显著 ,其次为AOBB组。结论 体外循环由替代途径激活补体系统 ,鱼精蛋白 肝素复合物由经典途径激活补体系统。国人补体 4基因型中 ,OOBB型出现的频率较白种人高 ,该基因型在体外循环中补体系统被激活及肺功能受损程度最严重
Objective To investigate the relationship between complement 4 gene polymorphism and complement activation and pulmonary dysfunction in cardiopulmonary bypass. Methods A total of 156 children undergoing open heart surgery under cardiopulmonary bypass (CPB) were enrolled in Wuhan City and the surrounding areas. Blood samples were collected before surgery for analysis of complement 4 genotype by using cross immunoelectrophoresis. Arterial blood samples were taken before CPB, at the end of CPB, and 10 min after protamine neutralization of heparin, respectively. The C3a and C4a of complement 3 and 4 activation products were determined by radioimmunoassay, and lung compliance was also recorded. Results The frequencies of AABB, AOBB, OOBB, AABO and AAOO in complement 4 genotype were 5 1.2 8%, 17.95%, 4.49%, 19 87% and 6 .41%, respectively. At the end of CPB, there was no significant increase of C4a level and a significant increase of C3a level. The levels of C4a and C3a were significantly increased 10 min after protamine neutralization of heparin, the most significant increase was seen in the OOBB group, followed by the AOBB group; the lung compliance of the OOBB group was the most significant, followed by the AOBB group. Conclusion Cardiopulmonary bypass activates the complement system by alternative pathways, and protamine heparin complexes activate the complement system by the classical pathway. In human complement 4 genotypes, OOBB occurs more frequently than Caucasians, and the complement is activated and has the most severe impairment of lung function during cardiopulmonary bypass