Antioxidant and Antiprotease Status in Peripheral Blood and BAL Fluid After Cardiopulmonary Bypass

Autor: Frank Bühling, Christof Huth, Heidrun Frass, Tobias Welte, Oliver M. Frass, Siegfried Ansorge, Michael Täger
Rok vydání: 2001
Předmět:
Blood Glucose
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Proteinase Inhibitory Proteins
Secretory
Inflammation
Critical Care and Intensive Care Medicine
Systemic inflammation
Antioxidants
law.invention
law
Internal medicine
Blood plasma
Cardiopulmonary bypass
Humans
Medicine
Protease Inhibitors
Secretory Leukocyte Peptidase Inhibitor
Sulfhydryl Compounds
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Pancreatic Elastase
biology
business.industry
Elastase
Extracorporeal circulation
C-reactive protein
Proteins
Middle Aged
respiratory system
Cathepsins
Systemic Inflammatory Response Syndrome
Blood Cell Count
Oxygen
Endocrinology
alpha 1-Antitrypsin
Immunology
biology.protein
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Bronchoalveolar Lavage Fluid
SLPI
Zdroj: Chest. 120:1599-1608
ISSN: 0012-3692
DOI: 10.1378/chest.120.5.1599
Popis: Objective Cardiopulmonary bypass (CPB) triggers systemic inflammation. Recent evidence suggests that metabolic and oxygenation management can affect the outcome of patients after cardiac surgery. We investigated the influence of oxidant/antioxidant and protease/antiprotease imbalance during the course of systemic and pulmonary inflammation. Methods In a study of 61 patients, we measured the intracellular thiol concentration, the intracellular activity of cathepsins and elastase, and the concentrations of secreted elastase, solubleα 1 -proteinase inhibitor (α 1 -PI), and secretory leukoprotease inhibitor (SLPI). Peripheral blood and BAL fluid (BALF) were obtained preoperatively and 2 h after CPB. Results A post-CPB depletion of thiol was found in blood granulocytes, lymphocytes, and monocytes, as well as BALF lymphocytes and macrophages. The degree of postoperative depletion correlated with P o 2 and blood glucose levels during CPB. Concomitant reduction of FEV 1 showed positive correlation with thiol depletion of blood monocytes and granulocytes. Elastase and cathepsin activities were increased in blood cells but not in lymphocytes or macrophages from BALF. The concentrations of secreted elastase were significantly increased in blood plasma but not in BALF. Enhanced antiprotease (α 1 -PI, SLPI) concentrations were measured in BALF but not in peripheral blood. Conclusions The inflammatory response of the intra-alveolar compartment is clearly distinguishable from systemic inflammation. CPB causes a differentiated impairment of the antioxidant defense system as well as a protease/antiprotease imbalance in blood and BALF. Oxygenation under circumstances of CPB and concomitant pulmonary disease, as well as blood glucose metabolism, influence the antioxidative defense. Individual perioperative management of blood glucose and oxygenation could improve cellular defense systems in the peripheral blood and BALF and therefore result in a more favorable patient outcome.
Databáze: OpenAIRE
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