重组人生长激素对风湿性心脏病患者围术期T淋巴细胞亚群影响的随机对照研究

Impact of Recombinant Human Growth Hormone on T Lymphocyte Subsets in Perioperative Patients with Rheumatic Heart Disease: A Randomized Controlled Trial

目的探讨重组人生长激素对风湿性心脏病患者围术期T淋巴细胞亚群的作用。方法采用随机、双盲对照的方法,纳入2011年6月1日至2012年3月31日襄阳市中心医院心胸外科收治的65例风湿性心脏瓣膜病患者,采用SAS产生的随机序列,将患者分为试验组(35例,其中男19例、女16例,平均年龄50.57岁)和对照组(30例,其中男16例、女14例,平均年龄49.87岁),除强心、利尿、极化液、术后抗感染等治疗外,试验组术前1 d,术后第1 d、第2 d、第3 d每天腹壁皮下注射重组人生长激素水针剂5 U(1 ml),对照组腹壁皮下注射0.9%生理盐水1 ml。每例患者于术前2 d、术后第1 d、第3 d、第7 d清晨采取外周静脉血,流式细胞仪即时测定T淋巴细胞亚群(CD3+、CD4+、CD8+)百分数并计算CD4+/CD8+比值。结果对照组术后第1 d、第3 d、第7 d CD3+、CD4+、CD4+/CD8+比值均较术前明显下降,CD8+术后第1 d、第3 d明显低于术前水平,且差异有统计学意义(P<0.05);试验组CD3+、CD4+、CD8+术后第1 d、第3 d低于术前水平,且差异有统计学意义(P<0.05),至术后第7 d其水平与术前差异无统计学意义(P>0.05),CD4+/CD8+比值术后第1 d低于术前水平(P<0.05),术后第3 d、第7 d与术前差异无统计学意义(P>0.05);试验组与对照组术前T淋巴细胞亚群差异无统计学意义(P>0.05),术后第1 d CD4+、CD4+/CD8+比值试验组高于对照组(P<0.05),至术后第3 d、第7 d CD3+、CD4+、CD4+/CD8+比值试验组则明显高于对照组,差异有统计学意义(P<0.05)。结论重组人生长激素可提高风湿性心瓣膜病患者围术期T淋巴细胞亚群的表达,改善机体细胞免疫能力,促进术后机体的恢复。

Objective To explore the impact of recombinant human growth hormone （rhGH） on T lymphocyte subsets in patients with rheumatic heart disease during the perioperative period of heart valve replacement. Methods A total of 65 patients with rheumatic valvular heart disease who received heart valve replacement in Department of Cardio- thoracic Surgery of Xiangyang Central Hospital from June 1, 2011 to March 31, 2012 were enrolled in this double-blind randomized controlled clinical study. All the patients were divided into 2 groups by random number produced by SAS software： the trial group and the control group. There were 35 patients in the trial group including 19 males and 16 females with their average age of 50.57 years, and 30 patients in the control group including 16 males and 14 females with their average age of 49.87 years. Apart from routine cardiac glycosides, diuretics, glucose-insulin-potassium solution, and postoperative anti-infective therapy, patients in the trial group also received subcutaneously injection of rhGH 5 U （ 1 ml ） daily from 1 day before surgery to 3 days after surgery, and patients in the control group received subcutaneously injection of normal saline 1 ml as placebo. Peripheral venous blood samples were taken in the morning 2 days before surgery and1 st, 3 rd, 7 th day after surgery respectively. Percentages of CD3＋, CD4＋ , CD8＋ were examined timely by flow cytom- etry and CD4＋/CD8＋ ratio was calculated. Results In the control group, percentages of CD3＋, CD4＋ and CD4＋/CD8＋ ratio on the 1 st, 3rd, 7th postoperative day were significantly lower than preoperative levels, and percentages of CD8＋ on the 1st and 3rd postoperative day were significantly lower than preoperative level （P〈0.05）. In the trial group, percent- ages of CD3＋, CD4＋ , and CD8＋ on the 1st and 3rd postoperative day were significantly lower than preoperative levels （P〈 0.05 ）, while percentages of CD3＋, CD4＋ , and CD8＋ on the 7th postoperative day were not statistically different from preoperative levels （P 〉 0.05） ; CD4＋/CD8＋ ratio on the 1st postoperative day was significantly lower than preoperative level （P 〈0.05）, while CD4＋/CD8＋ ratios on the 3rd and 7th postoperative day were not statistically different from preoperative level （P〉0.05）. There was no statistical difference in preoperative T lymphocyte subsets between the trial group and the control group （P〉 0.05）. The percentages of CD4＋ and CD4＋/CD8＋ ratio in the trial group were significantly higher than those of the control group on the 1 st postoperative day （P 〈 0.05）, while the percentages of CD3＋ and CD4＋ and CD4＋/CD8＋ ratio in the trial group were significantly higher than those of the control group on the 3rd and 7th postoperative day （P 〈 0.05）. Conclusion Use of rhGH can significantly increase T lymphocyte subsets expression, enhance body cellular immunity, and improve postoperative recovery of patients with rheumatic valvular heart disease during the perioperative period of heart valve replacement.