精氨酸对体外循环术后细胞免疫功能变化的影响

CELLULAR IMMUNOMODULATORY EFFECTS OF ARGININE ON CARDIOPULMONARY BYPASS PATIENTS

６０例体外循环手术患者分为实验与对照两组。实验组于术前３天至术后７天静脉滴注精氨酸，对照组输等量葡萄糖液。于术前，麻醉后，体外循环术后１、３、５、７、１４天等时点，抽外周血测定Ｔ细胞亚群和自然杀伤细胞活性。结果证实，精氨酸能明显减少体外循环术后细胞免疫功能下降幅度，缩短恢复至正常所需的时间。

It is still unknown whether arginine can enhance the immune function in patients after CPB. This randomized,prospective trial evaluated the immunomodulatory effects of arginine(arginine hydrochloride) given at 0. 2 g/kg/d by i.v. drip for the experimental group (n=30) and vehicle only for the control group(n=30) from preoperative day 3 to postoperative day 7. Peripheral blood lymphocyte subsets which represent specific cellular immunity were determined by using monoclonal antibodies OKT3, OKT4, OKT8 and natural killer(NK) which represents non-specific cellular immunity was measured by 125 I-UDR method.Models of CPB machine and oxygenator, mean CPB time, types and stages of disease, quantity of blood transfusion, nutrient condition, calories and nitrogen intake on perioperative period were not significantly different between the two groups. The results showed that arginine significantly enhanced T helper cell activity and NK cytotoxicity compared with the control group on the postoperative days 5-7,and reduced the recovery time of cell-mediated immune dysfunction to normal from 14 days in the control group to 7 days in the experimental group. As a nutrient substrate,arginine is nontoxic,and may benefit the CPB patients who are in danger of infection.