体外循环对瓣膜替换病人T淋巴细胞免疫功能的影响

Effect of Cardiopulmonary Bypass on Circulating T Lymphocyte Function in Patients with Cardiac Valve Replacement

探讨体外循环对心脏瓣膜替换病人外周血Ｔ淋巴细胞免疫功能的影响。作者对９例单瓣膜替换和７例双瓣膜替换病人的Ｔ淋巴细胞亚群、ＩＬ－２诱生能力和ＳｍＩＬ－２Ｒ＋表达水平在术前和术后１、３、７、１４天进行动态检测。结果显示术后早期、ＩＬ－２和ＳｍＩＬ－２Ｒ＋值均较术前明显降低；ＩＬ－２和ＳｍＩＬ－２Ｒ＋的下降，双瓣膜替换者较单瓣膜替换者更明显；均于术后７～１４天恢复。表明体外循环能明显抑制这类手术病人的Ｔ淋巴细胞免疫功能，抑制程度与体外循环时间和输血量有关。故认为围术期应采取保护和增强病人免疫功能的综合措施。

Purpose:This study was carrid out to determine the effect of cardiopulmonary bypass(CPB)on the immunologic function of T Lymphocyte in patients having valve replacement for rheumatic heart valvular disease。Materials and methods:in 9 patients having single valve replacement(group A)and 7 patients with double valve replacement(group B).T-Lymphocytes(CD3+)and their subsets(CD4+,T-helper and CD8+,T-suppressor cells),production of interleukin-2(IL-2),and expression of interleukin-2 receptor(IL-2R)of peripheral blood mononuclear cell(PBMC)on preoperation day and 1,3,7,14 days after operation were studied. ResuIts:The results showed that CD3+ cells count,percentage of CD4+ cells,CD4+/CD8+ ratio,IL-2 synthesis ability of PBMC,expression of IL-2R on surface of PBMC decreased significantly on the early postoperative days as compared with preoperative values(P<0.01).In addition,the number of CD4+cells,the levels of IL-2 production and IL-2R expression showed more significant depression in group B patients than in group A patients(P<0. 05 or 0.0l).All these parameters retumed to preoperative levels within 7 to l4 days。Conclusion:The above data suggest that T Lymphocyte immunologic function was significantly depressed for at least one week following CPB,It also appears that both blood transfusion from random donors and the duration fo CPB may contribute to this depression。All effective measures should be taken to offer sufficient protection of the cellmediated immunity.