体外循环心内直视手术对先天性心脏病患儿活化T淋巴细胞的影响及意义

The effect of cardiopulmonary bypass on the activation of peripheral T lymphocytes in children under open-heart operation

目的 探讨小儿体外循环心内直视手术对先天性心脏病患儿围手术期外周血T淋巴细胞表面活化分子CD69、人类白细胞抗原DR位点 (HLA -DR)表达的影响及其意义。方法 采用流式细胞仪动态测定42例先天性心脏病患儿术前、术中 (转流中 )及术后1h、24h、48h、72h6个时点外周血CD3+ /CD69+ 、CD3+ /HLA -DR+ 的百分率。 结果 体外循环转流中即可见CD3+ /CD69+ 增加 ,术后1h达最高峰 ,术后72h恢复至术前水平 ;CD3+ /HLA -DR+ 在术后1h开始增高 ,术后48h即恢复到术前水平 ,术后72h低于术前水平。 结论 小儿体外循环心脏直视术后早期T淋巴细胞活化增强 ,晚期活化受抑制。

Objective To evaluate the influence and significance of cardiopulmonary bypass (CPB) on the activation of peripheral blood T lymphocytes in children under open-heart surgery for congenital heart disease (CHD).Methods The expression of CD69 and HLA-DR on peripheral blood T cells (CD3+) were measured by Flow Cytometry (FCM) of 42 CPB cases at six various time points (preoperative, during CPB and 1, 24, 48, 72 hours after operation).Results During CPB, the expression of CD69 on CD3+ cell was significantly higher than preoperative levels (P<0.05).The levels peaked at 1 hr and recovered at 72 hrs after operation. The expression of late phase T lymphocyte activation molecules CD3+/HLA-DR+ started increasing at 1 hr, recovered at 48 hrs after surgery and the levels were lower than preoperative values at 72 hrs after operation.Conclusion The data indicate that cardiopulmonary bypass may enhance the early phase T lymphocyte activation and inhibit the late phase T lymphocyte activation.