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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 309-317, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
ME Faymonville, J Pincemail, J Duchateau, JM Paulus, A Adam, G Deby-Dupont, C Deby, A Albert, R Larbuisson and R Limet
To assess leukocyte activation during cardiopulmonary bypass, we measured
white blood cell and neutrophil counts and lysosomal enzyme release,
especially myeloperoxidase and elastase, throughout the operation and for 5
days postoperatively. A newly developed double antibody radioimmunoassay of
myeloperoxidase and an enzyme-linked immunosorbent assay for detection of
the polymorphonuclear elastase- alpha 1-proteinase inhibitor complex were
used to determine their plasma levels in 15 patients undergoing elective
aorta-coronary bypass grafting. Preoperatively white blood cell counts and
plasmatic levels of myeloperoxidase and elastase-alpha 1-proteinase
inhibitor were normal. Because no correlation has yet been established
between levels of myeloperoxidase and elastase-alpha 1-proteinase
inhibitor, the aim of this prospective study was to evaluate the use of
these enzyme levels as markers for leukocyte activation in vivo. We
addressed the clinical situation of cardiopulmonary bypass because it
offered the possibility of monitoring the comparative evolution of blood
levels of these enzymes in parallel to white blood cell counts through
well- defined steps corresponding to known events. We document the
advantages of myeloperoxidase blood levels over elastase measurement as
reflecting more rapidly the in vivo activation of leukocytes. The time
course kinetics of these three measurements were not parallel. White blood
cell counts remained stable at the beginning of bypass, whereas
myeloperoxidase levels increased sharply and continuously as soon as bypass
was instituted until the end of bypass. Elastase levels also increased, but
later than myeloperoxidase, beginning when the patients was rewarmed. High
elastase plasma levels persisted later than myeloperoxidase after bypass,
in parallel with white blood cell counts. It thus clearly appears that
changes in myeloperoxidase levels more rapidly reflect the activation state
of leukocytes induced by cardiopulmonary bypass and surgery, whereas peak
levels of elastase were delayed and parallel to white blood cell counts.
From this model, in which the evolution of leukocyte numbers could be
followed in relation with known steps of stimulation, it appears that
myeloperoxidase is a sensitive marker for monitoring in vivo activation of
white blood cells.
ARTICLES
Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans
Department of Anesthesiology, University of Liege, Belgium.
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