体外循环对T淋巴细胞细胞免疫功能的影响

Influence of Cardiopulmonary Bypass to the Cellular Immune Function of T Lymphocyte

目的观察体外循环（CPB）对T淋巴细胞细胞免疫功能的影响，以探讨CPB致机体免疫功能失调的内在机制。方法在我科2006年3～9月收治的500例手术患者中，随机抽取30例在CPB下行二尖瓣置换术的风湿性心瓣膜病患者为CPB组；30例动脉导管未闭在非CPB下行动脉导管结扎术患者为非CPB组。于术前、停机前或手术结束时、术后24h取血分离T淋巴细胞，对T淋巴细胞的数量、凋亡、细胞杀伤能力进行检测。结果停机前CPB组T淋巴细胞计数较术前减少（50．9％±6．8％VS．58．5％±9．1％，P〈0．05）；停机前和术后24hT淋巴细胞凋亡率较术前升高（6．5％±2．2％VS．0．9％±1．1％，5．6％±1．8％VS．0．9％±1．1％；P〈0．01）；停机前和术后24hT淋巴细胞对肿瘤细胞的杀伤能力较术前降低（30．4％±6．0％VS．37．3％±8．6％，29．0％±4．9％VS．37．3％±8．6％；P〈0．05）。停机前CPB组T淋巴细胞对肿瘤细胞杀伤能力明显低于非CPB组（30．4％±6．0％VS．33．6％±5．3％，P〈0．05）。结论CPB可抑制T淋巴细胞的细胞免疫功能，CPB过程中机体处于短暂的免疫抑制状态。

Objective To investigate the influence of cardiopulmonary bypass （CPB） to the cellular immune function of T lymphocyte. Methods Among 500 patients operated from March 2006 to September 2006, 30 patients with rheumatic heart disease were selected randomly as the CPB group, which would replace mitral valve; 30 patients with congenital patent ductus artereriosus as the non-CPB group, which would ligate ductus arteriosus without CPB. The blood was sampled before operation, at the end of CPB or operation, and 24 hours after operation. After T lymphocyte was seperated, the quantum of T lymphocyte, apoptosis of T lymphocyte, ability of T lymphocyte to kill turnout cell were measured. Results The quantum of T lymphocyte in CPB group at the end of CPB was decreased than that before operation （50. 9%± 6. 8% vs. 58. 5%± 9. 1%, P〈0. 05）; apoptosis of T lymphocyte at the end of CPB and 24 hours after operation were increased than that before operation （6.5% ±2.2% vs. 0.9%±1.1%, 5.6%±1.8% vs. 0.9%±1.1%;P〈0.01）; ability to kill tumour cell breakdown inCPBgroup at the end of CPB and 24 hours after operation was decreased than that before operation （30. 4%± 6. 0% vs. 37.3%±8.6%, 29.0%±4.9% vs. 37.3%±8.6%P〈0.05）. Ability to kill tumour cell breakdown inCPBgroup was lower than that in non-CPB group at the end of CPB （30. 4%±6. 0% vs. 33. 6%±5. 3%, P〈0. 05）. Conclusion CPB can depress the cellular immune function,which causes temporary immune depression to the body.