RI (CD64), and scavenger receptor CD163 on peripheral blood cells of cardiac surgical patients and to examine the effect of cardiac bypass as a separable influence on the systemic acute inflammatory response.
Methods.
Forty patients, twenty in each group, were randomly assigned to CABG surgery performed either with “on-pump” or without “off-pump” cardiopulmonary bypass. Standardized quantitative flow cytometry method was used to determine the expression of surface markers.
Results.
The density of CD64 molecule on monocytes reached maximum on the 1st postoperative day () whereas the peak for CD64 molecule expression on granulocytes was postponed to the 3rd
postoperative day (). The expression of CD163 scavenger molecule on monocytes reached maximum on the 1st postoperative day
(). The density of CD163 molecule on monocytes on the 1st postoperative day is
significantly higher in “on-pump” patients in comparison
with “off-pump” patients ().
Conclusion.
In cardiac surgical patients the expression of activation marker FcR1 (CD64) on monocytes is increased earlier in comparison with granulocytes in
both “on-pump” and “off-pump” patients. The expression of scavenger
molecule CD163 on monocytes is significantly higher in “on-pump” patients.">
FC RI（CD64）对心脏手术患者单核细胞的早期表达及“在泵”患者中单核细胞抗炎清除剂CD163受体的高密度据/title>
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no-repeat 6px;background-position:center;margin-top:10px;min-width:55px;display:none;} @media (min-width:768px){.hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption .expand_btn{display:none;}} .hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-text{-webkit-flex:9;-ms-flex:9;flex:9;text-align:left;padding:21px 37px 10px 0px;font-size:16px;font-weight:700;} @media (min-width:768px){.hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-text{padding:19px 18px 10px 18px;}} @media (min-width:992px){.hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-text{padding:19px 21px 10px 21px;}} .hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption 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no-repeat 6px;background-position:center;padding:16px 0 16px 0;min-width:62px;max-width:62px;} @media (min-width:768px){.hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-partial-url{padding:16px 0 17px 0;min-width:52px;max-width:52px;}} @media (min-width:992px){.hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-partial-url{padding:15px 0 17px 0;min-width:60px;max-width:60px;}} .hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption .caption-partial-url:hover{-webkit-text-decoration:none;text-decoration:none;} .hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption-text{font-size:14px;padding:0px 18px 17px 22px;} @media (min-width:768px){.hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption-text{padding:0px 15px 15px 18px;}} @media (min-width:992px){.hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption-text{padding:0px 18px 19px 21px;}} .hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption-text figcaption{margin:0;padding:0;} .hDZsgu .floats-partial-section .floats-partial-footer .floats-partial-caption-text svg{max-width:100%;} .hDZsgu ol{font-size:16px;padding-left:32px;font-family:STIXGeneral-Regular;line-height:24px;margin:15px 0;} .hDZsgu ol li{margin:10px 0;padding-left:10px;word-break:normal;} .hDZsgu ol li a{word-break:break-all;} .hDZsgu ol li .reflinks{display:block;} .hDZsgu ol li .reflinks a{color:#4D8A17;-webkit-text-decoration:none;text-decoration:none;cursor:pointer;} .hDZsgu ol li .reflinks a:hover{-webkit-text-decoration:underline;text-decoration:underline;} .hDZsgu ol li .reflinks .sep{color:#000000;} .hDZsgu .table-wrapper{width:auto;overflow-x:auto;} .hDZsgu .table-wrapper::-webkit-scrollbar{-webkit-appearance:none;width:5px;height:5px;} .hDZsgu .table-wrapper::-webkit-scrollbar-thumb{border-radius:5px;background-color:rgba(0,0,0,.5);-webkit-box-shadow:0 0 1px rgba(255,255,255,.5);} @media (min-width:768px){.hDZsgu .table-wrapper{overflow-x:auto;width:auto;-webkit-break-word:word-break;break-word:word-break;margin:0 auto;}} @media (min-width:992px){.hDZsgu .table-wrapper{width:auto;}} @media (min-width:1324px){.hDZsgu .table-wrapper{width:auto;}} @media (min-width:320px){.hDZsgu{margin-bottom:33px;padding:0;}} @media (min-width:992px){.hDZsgu{padding:0;margin-bottom:100px;}} @media (min-width:1325px){.hDZsgu{margin-bottom:100px;}} .hDZsgu .owl-stage{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;} .hDZsgu .floats-partial-middle--thumbs{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;} .hDZsgu .floats-partial-middle--thumbs .partial-carousel-dot svg{fill:#4D8A17;} .hDZsgu .floats-partial-middle--thumbs .partial-carousel-dot strong{color:#4D8A17;font-weight:500;} .hDZsgu .floats-partial-middle--thumbs .partial-carousel-dot.active strong{color:#007B8B;} .hDZsgu 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<p><sup>1据/sup><span>布拉格查尔斯大学医学院临床免疫和过敏学系，捷克共和国索科斯卡街581号，布拉格Králové 50005据/span></p>
<p><sup>2据/sup><span>Charles大学HradecKrálové的医学院主动学院，Sokolska Street 581，HradecKrálové50005，捷克共和国据/span></p>
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<h4 class="header" id="abstract">摘要据/h4>
<p><i>客观的据/i>．先天免疫细胞的激活与心脏外科手术密不可分。本研究的目的是评估动力学，以表达FC，FC的FC部分据svg height="9.9375" id="M2" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
<g transform="translate(72,-64.05)">
<text transform="matrix(1,0,0,-1,-71.95,66.44)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
</text>
</g>
</g>
</svg>心脏手术患者外周血细胞中RI (CD64)和清道夫受体CD163的作用，并检验心脏旁路术作为一种可分离的影响对全身急性炎症反应的影响。据i>方法据/i>．每组二十名患者，每组2例，随机分配给CABG手术，以“泵”或没有“泵”心肺心肺旁路进行。标准化定量流式细胞术方法用于确定表面标志物的表达。据i>结果据/i>．单核细胞CD64分子密度在术后第1天达到最大值(据svg height="11.0625" id="M3" style="vertical-align:-0.30096pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 11.0625" width="56.150002" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
<g transform="translate(72,-63.15)">
<text transform="matrix(1,0,0,-1,-71.95,63.5)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
<tspan style="font-size: 12.50px; " x="10.890113" y="0">
据据/tspan>
<tspan style="font-size: 12.50px; " x="22.930502" y="0">
．据/tspan>
<tspan style="font-size: 12.50px; " x="26.056252" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="32.307751" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="38.559254" y="0">
1据/tspan>
</text>
</g>
</g>
</svg>)，而粒细胞CD64分子表达峰值推迟至术后第3天(据svg height="11.0625" id="M4" style="vertical-align:-0.30096pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 11.0625" width="56.150002" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
<g transform="translate(72,-63.15)">
<text transform="matrix(1,0,0,-1,-71.95,63.5)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
<tspan style="font-size: 12.50px; " x="10.890113" y="0">
据据/tspan>
<tspan style="font-size: 12.50px; " x="22.930502" y="0">
．据/tspan>
<tspan style="font-size: 12.50px; " x="26.056252" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="32.307751" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="38.559254" y="0">
1据/tspan>
</text>
</g>
</g>
</svg>）.CD163清除剂分子对单核细胞的表达在术后一天达到最大值（据svg height="11.0625" id="M5" style="vertical-align:-0.30096pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 11.0625" width="56.150002" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
<g transform="translate(72,-63.15)">
<text transform="matrix(1,0,0,-1,-71.95,63.5)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
<tspan style="font-size: 12.50px; " x="10.890113" y="0">
据据/tspan>
<tspan style="font-size: 12.50px; " x="22.930502" y="0">
．据/tspan>
<tspan style="font-size: 12.50px; " x="26.056252" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="32.307751" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="38.559254" y="0">
1据/tspan>
</text>
</g>
</g>
</svg>）.与“泵”患者相比，“泵”患者在术后一天上的单核细胞上的CD163分子密度显着高于“泵”患者（据svg height="11.0625" id="M6" style="vertical-align:-0.30096pt;width:56.150002px;" version="1.1" viewbox="0 0 56.150002 11.0625" width="56.150002" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,11.0625)">
<g transform="translate(72,-63.15)">
<text transform="matrix(1,0,0,-1,-71.95,63.5)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
<tspan style="font-size: 12.50px; " x="10.890113" y="0">
据据/tspan>
<tspan style="font-size: 12.50px; " x="22.930502" y="0">
．据/tspan>
<tspan style="font-size: 12.50px; " x="26.056252" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="32.307751" y="0">
0.据/tspan>
<tspan style="font-size: 12.50px; " x="38.559254" y="0">
1据/tspan>
</text>
</g>
</g>
</svg>）.据i>结论据/i>．心脏手术患者中激活标记物Fc的表达据svg height="9.9375" id="M7" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
<g transform="translate(72,-64.05)">
<text transform="matrix(1,0,0,-1,-71.95,66.44)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
</text>
</g>
</g>
</svg>与“泵”和“泵”和“泵”患者的粒细胞相比，单核细胞上的R1（CD64）更早地增加。“泵”患者的单核细胞中清除剂分子CD163的表达显着高。据/p>
<span class="end-abs"></span>
<h4 id="introduction">1.介绍据/h4>
<p>在心脏手术过程中，会诱发许多可能产生炎症反应的事件。其中，手术损伤、对心脏的机械操作、血液成分与体外循环人工表面的接触、短暂内毒素血症和心脏和肺的缺血-再灌注损伤的结合都是相关的[据a href="#B1">1据/a>］．炎症反应是多种体液因子和炎症细胞底物复杂相互作用的结果。在参与这一过程的细胞中，特别的作用是先天免疫单核细胞-巨噬细胞和粒细胞。单核-巨噬细胞活化后是多能促炎细胞因子最丰富的来源，活化的粒细胞通过白细胞表面的粘附分子与炎症内皮细胞腔面表达的相应受体的逐步相互作用被招募到组织中[据a href="#B2">2据/a>］．持续持续的努力，鉴定各种刺激患者患者的血液中的活化的单核细胞和中性粒细胞，以鉴定患者患者患者，这些炎症患者可能与多个器官失败综合征（MOF）或其有关牵引这种炎症反应的致病剂，例如细菌感染[据a href="#B3">3.据/a>］．据/p>
<p>通过各种生理和实验刺激激活骨髓细胞伴随着主要与脱粒相关的多种表面变化。因此，活性血液髓样细胞通常上调趋化性受体的表面表达，补体受体型3（CD11b / CD18），并滴下脂多石酶（LPS）受体CD14，低亲和力Fc据span class="inline" id=""></span>RIII或CD16受体，粘附受体CD44和CD62L [据a href="#B4">4.据/a>］．据/p>
<p>FC.据span class="inline" id=""></span>受体,足球俱乐部据span class="inline" id=""></span>RI (CD64)是IgG1和IgG3亚类免疫球蛋白的高亲和力受体。FC.据span class="inline" id=""></span>RI在单核细胞和巨噬细胞上呈高密度组构表达，在嗜酸性粒细胞上表达较少，但在静息中性粒细胞上表达极低。据/p>
<p>许多物质外源性和内源性起源迅速上调FC据span class="inline" id=""></span>中性粒细胞表面RI表达[据a href="#B5">5.据/a>］．微生物细胞壁组分如LPS，内源补体分裂产品和细胞因子，如IFN据span class="inline" id=""></span>和tnfα是一些活化剂。FC的表达据span class="inline" id=""></span>通过免疫荧光和流式细胞术确定RI。新的诊断套件Leuko64的引入使标准化和定量方法能够确定FC据span class="inline" id=""></span>在免疫细胞上的表达。据/p>
<p>血红蛋白清道夫受体CD163是一种B族富半胱氨酸清道夫受体，仅由单核细胞-巨噬细胞系细胞表达。这种糖蛋白的特征是血红蛋白的清道夫受体，介导血红蛋白-触珠蛋白复合物的内吞作用。先前的研究间接地将CD163清清剂受体与抗炎现象联系起来[据a href="#B6">6.据/a>］．高CD163表达与单核细胞和巨噬细胞的MO2抗炎特性相关[据a href="#B7">7.据/a>］．据/p>
<p>本研究的目的是遵循粒细胞活化标志物FC表达的变化据span class="inline" id=""></span>在心脏外科手术中，无论是使用体外循环(“泵上”)，还是在“泵下”手术中对跳动的心脏进行手术，以及在术后期间使用定量流式细胞术的患者中，RI和抗炎CD163清除受体。据/p>
<h4 id="patients">2.病人据/h4>
<p>40例，男性31例，平均年龄据svg height="9.9375" id="M8" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
<g transform="translate(72,-64.05)">
<text transform="matrix(1,0,0,-1,-71.95,66.44)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
</text>
</g>
</g>
</svg>9名女性，平均年龄据svg height="9.9375" id="M9" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
<g transform="translate(72,-64.05)">
<text transform="matrix(1,0,0,-1,-71.95,66.44)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
</text>
</g>
</g>
</svg>，集体平均年龄据svg height="9.9375" id="M10" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
<g transform="translate(72,-64.05)">
<text transform="matrix(1,0,0,-1,-71.95,66.44)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
</text>
</g>
</g>
</svg>第一次冠状动脉旁路移植术(CABG)被纳入本研究。患者接受常规的心肌血运重建术(体外循环)和心脏骤停(“泵上”，据i>N据/i>= 20,16男性，4女性，平均年龄据svg height="9.9375" id="M11" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
<g transform="translate(72,-64.05)">
<text transform="matrix(1,0,0,-1,-71.95,66.44)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
</text>
</g>
</g>
</svg>)或心脏手术(“off-pump，”据i>N据/i>=20, 15男性，5女性，平均年龄据svg height="9.9375" id="M12" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
<g transform="matrix(1.25,0,0,-1.25,0,9.9375)">
<g transform="translate(72,-64.05)">
<text transform="matrix(1,0,0,-1,-71.95,66.44)">
<tspan style="font-size: 12.50px; " x="0" y="0">
据/tspan>
</text>
</g>
</g>
</svg>）.据/p>
<p>两组患者在年龄、术前左室射血分数(“泵入”患者中位数为0.65，“非泵入”患者中位数为0.65)和冠状动脉吻合次数(“泵入”患者中位数为2.0，“非泵入”患者中位数为2.0)方面具有相似性。该研究方案得到了Hradec Králové大学医院伦理委员会的批准。所有的参与者都被口头和书面详细地告知了研究的目的。他们可以自由提问。有一个人拒绝参加，原因他不愿透露。所有受试者已给予书面知情同意。据/p>
<p>体外循环，“非泵”技术和麻醉管理最近已在其他地方详细描述[据a href="#B8">8.据/a>］．据/p>
<h4 id="blood-sampling">3.血液取样据/h4>
<p>来自前臂静脉的外周静脉血在手术室和重症监护病房被抽出。标本采集于肝素化管中。不。36884由Becton Dickinson制造。据/p>
<p>在“泵”和“泵”患者中，在以下时间点撤回血液：据/p>
<p><span class="list"><span class="list-item"><span class="list-label">（1）据/span><span class="list-content">麻醉的介绍，在两组中都代表随后测量的所有参数的基线或参考值，据/span></span><span class="list-item"><span class="list-label">（2）据/span><span class="list-content">操作终止后，据/span></span><span class="list-item"><span class="list-label">（3）据/span><span class="list-content">术后第一天，据/span></span><span class="list-item"><span class="list-label">（4)据/span><span class="list-content">第三天，据/span></span><span class="list-item"><span class="list-label">（5）据/span><span class="list-content">术后第七天。据/span></span></span>从“泵内”患者中采集额外样本:据/p>
<p><span class="list"><span class="list-item"><span class="list-label">(1)据/span><span class="list-content">在主动脉交叉夹紧之前，据/span></span><span class="list-item"><span class="list-label">(1 b)据/span><span class="list-content">在主动脉的交叉夹具释放后，据/span></span><span class="list-item"><span class="list-label">（1c）据/span><span class="list-content">CPB终止后。据/span></span></span></p>
<h4 id="materials-and-methods">4.材料和方法据/h4>
<p>Leuko64试剂盒由Trillium Diagnostics, LLC， (据a href="http://www.trilliumdx.com" target="_blank">www.trilliumdx.com.据/a>检测CD64和CD163在外周血白细胞中的表达。Leuko64试剂盒由两种特异性CD64单克隆抗体(克隆22和32.2，均与FITC偶联)和CD163单克隆抗体(克隆Mac2-148，藻红蛋白偶联物)和一种荧光珠悬浮液，用于仪器校准和标准化人血液中白细胞CD64和CD163的表达。根据生产厂家提供的说明书进行测定。简单地说，50微升血液和Leuko64单克隆鸡尾酒试剂孵育10分钟，加入红细胞裂解缓冲液并再孵育15分钟，在流式细胞分析前加入5微升珠悬液。采用FACSCalibur流式细胞仪(BD Biosciences, San Jose, california, USA)，使用CELLQuest软件测量结果。listmode数据采用Leuko64软件(Trillium Diag.)进行分析。结果用Leuko64软件提供的CD64和CD163在粒细胞和单核细胞中表达阳性的指标来表达。据/p>
<h4 id="statistical-analysis">5.统计分析据/h4>
<p>我们分别比较两组患者(“泵上”和“非泵下”)CD64和CD163表达强度的变化。麻醉开始时采集的样本作为CD64和CD163的参考或基线表达。我们还评估了“关泵”和“开泵”患者之间的差异。据/p>
<p>数据采用双向方差分析进行重复测量，采用Fisher检验进行多重比较。为排除两组不同年龄、性别表现的混杂效应，采用非配对t检验和卡方检验。一个概率(据i>P.据/i>)值< .05被认为是显著的。采用Statistica 5.5软件(Statsoft, oklahoma, USA)进行统计学分析。据/p>
<h4 id="results">6.结果据/h4>
<p>我们在心脏手术患者的免疫细胞上发现了CD64和CD163分子表达的大量动态变化。这些变化分别表现为单核细胞和粒细胞的CD64和CD163指标的变化。以术前水平作为参考点。在心脏手术期间，“泵上”患者单核细胞CD64表达无显著变化(数据未显示)。从术后第1天到第7天，“泵入”和“非泵入”患者单核细胞CD64指数均显著升高(据i>P.据/i>< . 01)。“泵入”与“泵入”患者单核细胞CD64指数比较，差异无统计学意义(据i>P.据/i><.587）在术后和术后期间（图据a href="//www.newsama.com/journals/mi/2008/235461/fig1/" target="_blank">1据/a>）.在我们的心脏外科患者中也发现了类似的单核细胞CD163指数，但有以下例外。单核细胞CD163指数，与单核细胞CD64指数相比，显示出显著差异作为泵状态的函数。在术后第一天，“泵入”患者单核细胞CD163指数比“非泵入”患者显著增加(据i>P.据/i><.001）（图据a href="//www.newsama.com/journals/mi/2008/235461/fig2/" target="_blank">2据/a>）.与基线表达相比，“泵”和“泵”和“泵”患者的单核细胞CD163指数的显着增加仅在术后第1天和第3天（据i>P.据/i>< . 01)。据/p>
<div class="floats-partial-section partial-carousel-wrapper" data-section="fig1">
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<span class="caption-text">图1据/span>
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CD64分子在“泵入”和“非泵入”患者单核细胞中的表达。据/table>
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“泵”和“泵”患者单核细胞上的CD163分子表达。据/table>
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<p>在术后第1天和第3天，“泵入”和“非泵入”患者的粒细胞CD64指数均显著升高。“泵入”和“非泵入”的粒细胞CD64指标未达到有统计学意义的差异(据i>P.据/i><.195）（图据a href="//www.newsama.com/journals/mi/2008/235461/fig3/" target="_blank">3.据/a>）.在我们的结果中，原始的和病理生理学上非常重要的观察是，单核细胞上CD64表达最大值(术后第1天)先于粒细胞上CD64表达最大值(术后第3天)。术后第7天粒细胞CD64表达恢复到基线或正常水平。据/p>
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<span class="caption-text">图3据/span>
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CD64分子在“泵入”和“非泵入”患者粒细胞中的表达。据/table>
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<h4 id="discussion">7.讨论据/h4>
<p>长期以来，我们一直致力于更好地理解炎症反应，因为炎症反应与每一例心脏手术都密不可分。许多体液和细胞介导的免疫系统参数已经被研究，以确定描述这种炎症反应发展的标志物。这些研究的最终目标是确定那些具有发生压倒性全身炎症(SIRS)的重大风险的患者，这是一种复杂的生理状况，可能严重危及手术结果，甚至导致死亡。过去几年进行的许多研究表明，与“泵内”手术相比，“非泵内”手术患者的炎症减少[据a href="#B9">9.据/a>］．另一方面，任何支持“无泵”手术在降低长期死亡率方面优于“有泵”手术的确凿证据尚未被报道。手术的创伤似乎与启动SIRS更相关，而不是体外循环本身，后者在不利事件之上增加了体外循环的特定部分[据a href="#B10">10.据/a>］．据/p>
<p>本研究的目的是比较“泵”和“泵”患者之间先天免疫细胞的激活程度。我们使用了新型诊断髓鞘试剂盒来解剖这种差异。该试剂盒使流式细胞术能够定量测定在免疫细胞上的CD64 / CD163分子表达。据/p>
<p>FC.据span class="inline" id=""></span>R1受体（CD64）在巨噬细胞，单核细胞和嗜酸性粒细胞上构成型表达，但在休息中性粒细胞上的表达可以忽略不计。中性粒细胞CD64分子表达是在正常的先天免疫反应期间表现出许多活化相关的表面受体变化之一。微生物细胞壁组分如LP，补体分裂产品和细胞因子（IFN据span class="inline" id=""></span>,肿瘤坏死因子据span class="inline" id=""></span>)是一些激活因子[据a href="#B3">3.据/a>］．与许多其他嗜中性活化表面抗原相反，如CD11b / cd18，CD14和CD16具有大量储存细胞内池，CD64具有有限的细胞内储存，但是可以在促炎病症存在下诱导Novo合成。与以前的中性粒细胞活化标记物相比，脱噬细胞上的CD64表达受到抗脱粒的刺激的影响大大影响，这些细胞在心脏手术操作期间和血液样品处理期间都会被广泛暴露[据a href="#B5">5.据/a>］．因此，CD64分子似乎特别适合作为中性粒细胞激活或全身急性炎症反应的替代标记物，因为它的表达开始于每个细胞不到2000个位点，并根据细胞因子刺激的强度分级上调[据a href="#B4">4.据/a>］．据/p>
<p>CD64测定的临床有用性已被证明在细菌来源脓毒症的鉴别诊断中。还报道了CD64表达CD64表达循环白细胞患者进行心胸外科手术的患者[据a href="#B11">11.据/a>］．其中一些以前的作品患有缺乏精确定量，因为CD64阳性例如表达为平均荧光强度[据a href="#B11">11.据/a>那据a href="#B12">12.据/a>］．这种定量方法在单一平台上对日常比较有效，但缺乏常规临床实验室检测所需的标准化，而Leuko64试剂盒方法允许实验室间比较。在我们的研究中，一种新的标准化诊断试剂盒的应用克服了上述局限性。利用校准的荧光珠和专用软件，分别将粒细胞和单核细胞的CD64/CD163密度表示为指数阳性。正如预期的那样，单核细胞的CD64阳性比粒细胞高一个log。在术后第1天和第3天，单核细胞和粒细胞的CD64表达均显著增加。“泵入”和“非泵入”患者之间没有显著差异。尽管“泵入”和“非泵入”患者单核细胞的CD64表达几乎相同，但“泵入”患者的粒细胞CD64指数在术后第3天有升高的趋势。这可能反映了与单核细胞相比，粒细胞对细胞因子作用更敏感。我们的结果与Stefanou等人的工作相反[据a href="#B13">13.据/a>未发现体外循环后心脏手术患者单核细胞中CD64表达的任何诱导。然而，只有10例患者加入了他们的研究，与我们的患者相比，CPB有一些差异。此外，我们尝试使用Leuko64试剂盒，与之前的工作相比，确保了更好的方法标准化，在之前的工作中，阳性表达为简单的MFI。据/p>
<p>中性粒细胞CD64指数的设计使正常灭活细胞的值<1.00，而记录的脓毒症或SIRS患者的血液样本的值通常为>1.50。在我们的患者中，围手术期和术后都很顺利，只有一个例外，患者，将在下面讨论。我们最初观察到，我们心脏手术患者单核细胞上的CD64表达最大值已经在术后第1天达到，而粒细胞上的CD64表达最大值被推迟到术后第3天。这一观察结果表明Fc据span class="inline" id=""></span>单核细胞上的RI表达在操作过程中很早就通过不同的细胞机制上调，这是由于单核细胞在操作过程中提出的各种危险模式。Fc的上调据span class="inline" id=""></span>粒细胞RI是由单核-巨噬细胞形成的促炎细胞因子和介质介导的次级事件。据/p>
<p>FC.据span class="inline" id=""></span>在白细胞上的RI受体（CD64）整合涉及先天性和获得的免疫系统的反应，对细菌和免疫复合物的有效吞噬作用非常重要。最近通过Devaraj等人提出了这种受体的一种新的内在角色。谁描述了FC的参与据span class="inline" id=""></span>R研究内皮细胞对c反应蛋白的内化，随后释放趋化性促炎IL-8，减少eNOS，增加ICAM-1和VCAM-1粘附分子[据a href="#B14">14.据/a>］．总之，FC据span class="inline" id=""></span>RI一般揭示了促炎活动。据/p>
<p>促炎途径必须受到许多抗炎过程的抗衡性，即产生抗炎细胞因子，如IL-10 [据a href="#B15">15.据/a>]，以维持心脏外科病人炎症反应的保护性生理水平。另一种平息炎症反应的方法是通过所谓的清除受体的作用去除多效性的促炎物种，这些受体在免疫和非免疫来源的细胞上都有不同的表达[据a href="#B6">6.据/a>］．这些清道夫受体的独特特征揭示了血红蛋白清道夫受体(CD163)。CD163清除受体是一种高效的系统，可以从循环和局部炎症部位清除潜在的有毒和促炎血红蛋白[据a href="#B16">16.据/a>］．由于血管内溶血和组织损伤，心脏手术患者广泛暴露于大量游离血红素/血红蛋白。越来越多的证据表明游离血红素过量可导致细胞损伤和组织损伤。血红素催化活性氧(ROS)的形成，导致氧化应激。由于低分子量铁螯合血红素亲脂性，它容易嵌入细胞膜，损害脂质双分子层和细胞器，如线粒体和细胞核，并使细胞骨架不稳定[据a href="#B17">17.据/a>］．有几种防御机制对抗游离血红素介导的氧化应激和炎症。它们包括细胞内(如血红素加氧酶2和血红素加氧酶3)和细胞外(如血凝素、白蛋白)清除剂、抗氧化酶和溶血时的血红素加氧酶1。据/p>
<p>血管内游离血红蛋白被血浆清除蛋白结合珠蛋白捕获。人们普遍认为，稳定的血红蛋白-触珠蛋白复合物随后通过CD163受体介导的内吞作用传递到网状内皮系统[据a href="#B16">16.据/a>］．任何游离的血管血红素都与血浆蛋白血凝蛋白或白蛋白结合，将其运输到肝脏并在网状内皮系统中降解。然而，当大量游离血红素蛋白或血红素(局部)积聚时，比如在血凝块中或在血管沉积后，清除者就会不知所措或无法到达它们。这使得血红素发挥其破坏作用。因此，必须严格控制游离血红素的数量，以维持体内平衡，避免病理条件。据/p>
<p>我们的研究发现单核细胞CD163指数在5000到40000之间。术后单核细胞CD163急剧增加，达到统计学高度显著最大值(据i>P.据/i>< .001)，随后降至术前基线水平。此外，患者单核细胞CD163指数显著升高(据i>P.据/i><.001）在术后第1天的“泵”患者组中。心脏手术患者单核细胞CD163表达的报告非常稀疏。在Goldstein等人的一项研究中。[据a href="#B18">18.据/a>]，单核细胞CD163表达在术后第1天显著升高。这与我们的研究结果是一致的。但之前的一项研究有几个局限性。CD163分子以平均荧光指数(MFI)表示，而我们的研究使用校准荧光珠进行标准化定量，获得了更相关的数据。与之前的研究相比，我们跟踪了整个围手术期和术后至术后第7天的变化。据/p>
<p>在心脏手术患者中，CD163血红蛋白清除受体与抗炎现象的联系已经被Philippidis等人证实[据a href="#B19">19.据/a>］．在他们的研究中，报道了在体外循环手术后全身炎症反应的消退阶段，循环单核细胞中CD163的表达升高。此外，血红蛋白-触珠蛋白复合物与表达CD163的单核细胞结合引发了白细胞介素-10的分泌。Goldstein等人报道[据a href="#B18">18.据/a>在他们的“上泵”患者中，在围手术期给予甲泼尼松龙丸治疗的单核细胞CD163表达的增加是未经治疗的患者的14倍。在我们的患者中没有进行这种治疗干预。在我们的“泵上”患者中，高单核细胞CD163表达似乎不太可能是由我科使用的体外循环液的常规成分甲基强的松龙引起的。更明显的促炎刺激提高在“泵上”手术更相关。这将是一个独特的机会来剖析体外循环液体中皮质激素的影响和“泵上”手术中涉及的其他变量。目前我科使用的CPB方案已经改变，甲基强的松龙已被省略。CD163被LPS或佛波酯激活后迅速从单核细胞表面脱落。此外，还交联Fc据span class="inline" id=""></span>R触发CD163脱落[据a href="#B20">20.据/a>］．正如金属蛋白酶介导的CD163脱落所显示的那样，这种脱落之后血红蛋白清清剂受体的上调很可能抵消了这一现象[据a href="#B21">21.据/a>］．对于我们的心脏手术患者来说，这可能是如此。最近，它被韦弗等人证明。[据a href="#B22">22.据/a>发现TLR-4、TLR-2和TLR-5刺激也可诱导CD163的脱落。据/p>
<p>本研究最初纳入的是一位73岁的男性患者，他在术后第2天死亡，因此被排除在我们的研究之外。该患者接受了简单的体外循环心脏手术。术后2小时发生急性膈肌梗死。患者再次手术并再次吻合。尽管如此，还是发生了心源性休克和随后的失血性休克，最终在第二天早上死亡。体温低于据svg height="9.9375" id="M13" style="vertical-align:-2.34499pt;width:8.0625px;" version="1.1" viewbox="0 0 8.0625 9.9375" width="8.0625" xmlns="http://www.w3.org/2000/svg">
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</svg>c让感染不太可能。据/p>
<p>CD64和CD163分子在术前及术后的表达与其他患者相当。粒细胞CD64指数达到1.72，对SIRS的发生具有重要意义[据a href="#B23">23.据/a>］．然而，在额外的四名患者中发现了这些价值，而不会对其术后课程产生任何影响。卓越的是，本患者的单核细胞CD163指数是我们患者之间的最高价，与我们所调查的所有患者相比，与我们的所有患者相比大约增加了两倍。从这种轶事观察可以得出结论，CD163单核细胞阳性的增加可能是心脏手术患者中较差的结果预测值的标志物。据/p>
<p>总之，使用标准化定量方法，我们揭示了激活标记物Fc表达的实质动态据span class="inline" id=""></span>RI和清除剂受体CD163在“泵”和“泵”心脏手术患者手术期间和术后期间。在术后时期的单核细胞上表达CD64的最大值在该分子在粒细胞上表达两天的最大值。据/p>
<h4 id="acknowledgment">承认据/h4>
<p>这项工作得到了捷克青年、学校和体育活动部的研究项目的支持。MSM 0021620812和捷克共和国卫生部内部赠款机构，第2号。NR / 9090 - 4。据/p>
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<mi>
γ据/mi>
</math>受体I)细胞表面表达对早产儿和足月新生儿成熟中性粒细胞的影响据i>儿科学报》杂志上据/i>，第94卷，第94期3，页295-302,2005。据span class="reflinks">视图:据a href="https://scholar.google.com/scholar_lookup?title=CD64%20(Fc?%20receptor%20I)%20cell%20surface%20expression%20on%20maturing%20neutrophils%20from%20preterm%20and%20term%20newborn%20infants&author=G. Fjaertoft&author=L. Hakansson&author=T. Foucard&author=U. Ewald&author=&author=P. Venge&publication_year=2005" target="_blank">谷歌学术据/a></span></li>
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cardiopulmonary%20bypass%20surgery&author=P. Philippidis&author=J. C. Mason&author=B. J. Evans et al.&publication_year=2004" target="_blank">谷歌学术据/a></span></li>
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<mi>
γ据/mi>
</math>R引发血红蛋白结合珠蛋白清道夫受体CD163的脱落，”据i>白细胞生物学杂志据/i>，卷。76，pp。271-277,2004。据span class="reflinks">视图:据a href="https://doi.org/10.1189/jlb.1003523">出版商网站据/a><span class="sep">|据/span><a href="https://scholar.google.com/scholar_lookup?title=Cross-linking%20of%20Fc?R%20triggers%20shedding%20of%20the%20hemoglobin-haptoglobin%20scavenger%20receptor%20CD163&author=T. H. Sulahian&author=P. A. Pioli&author=K. Wardwell&author=&author=P. M. Guyre&publication_year=2004" target="_blank">谷歌学术据/a></span></li>
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<p>版权所有©2008 Martina Kolackova等。这是分布下的开放式访问文章据a rel="license" href="http://creativecommons.org/licenses/by/3.0/">创意公共归因许可证据/a>，允许在任何媒介上不受限制地使用、传播和复制，但必须正确引用原作。据/p>
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<span><img alt="" class="sc-EHOje jOLhQl sc-bfYoXt cGuwDn" title="" role="presentation" src="data:image/svg+xml;base64,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" height="24"><span class="sc-dRFtgE jrsDZP">下载其他格式据/span><span class="sc-gkFcWv gWTCXQ">更多的据/span></span>
<span class="sc-htoDjs bMdQcY sc-gbOuXE jGPvPL icon-colored _1CwL9R82TPl2HxDleeYGDR icon-themeable" title="" font-size="11"></span>
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XML据/div><img alt="" class="sc-EHOje jOLhQl sc-bfYoXt cGuwDn" title="" role="presentation" src="data:image/svg+xml;base64,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" height="24"></a>
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<div class="sc-dyGzUR cHatnS">
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