生脉注射液对体外循环所致机体免疫功能改变的影响  

Impact of Shengmai Injection on Changes of Immunological Function in Patients after Cardiopulmonary Bypass

作　　者：于建华[1] 郭宏伟[1,2] 刘美明[3] 吴树明[1] 张供[1] 廖崇先[2] 

机构地区：[1]山东大学齐鲁医院心脏外科,山东250012 [2]厦门大学附属中山医院厦门心脏中心心血管外科 [3]山东省胸科医院心血管中心

出　　处：《中国中西医结合杂志》2009年第4期317-321,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：2002年山东省中青年优秀科学家奖励基金资助项目(No.9834)

摘　　要：目的探讨围术期使用生脉注射液对体外循环所致机体免疫功能改变的影响及其作用机制。方法选择40例风湿性心脏瓣膜病患者,随机分为对照组(20例)及生脉注射液治疗组(简称生脉组,20例)。分别在术前第3天、体外循环结束后10min、术后第1天、第3天及第7天检测外周静脉血白细胞计数、中性粒细胞计数、淋巴细胞计数、T淋巴细胞亚群(CD3+、CD4+、CD8+及CD4+/CD8+比值)、血清免疫球蛋白(IgG、IgA、IgM)及白细胞介素(Interleukin,IL)-8、IL-10浓度。结果与对照组比较,生脉组白细胞计数、中性粒细胞计数在体外循环结束后10min均显著降低(P<0.01);CD3+及CD4+在术后第3、7天显著降低(P<0.05,P<0.01);CD8+在体外循环后各时段显著升高(P<0.05,P<0.01);CD4+/CD8+比值在术后第1、3、7天均降低(P<0.05,P<0.01);IgG在体外循环结束后10min降低(P<0.05),IgA在术后第1天升高(P<0.05);IgM在术后第1、3、7天升高(P<0.05);IL-8在体外循环后各时段降低(P<0.05);IL-10在体外循环结束后10min升高(P<0.05)。结论心脏瓣膜置换患者围术期使用生脉注射液,能增强体外循环术后体液免疫功能,抑制细胞免疫功能,减轻全身性炎症反应,改善预后。Objective To study the impact and mechanism of Shen logical function changes after cardiopulmonary bypass. Methods Forty pa ease were selected and assigned randomly to two groups： 20 in the contro gmai Injection （SMI） on the immunotients with rheumatic heart valve disgroup and 20 in the SMI group. Peripheral blood samples were taken at various time points, i.e. 3 days before operation （T1）, 10 min after terminal of CPB （T2） , the first （T3） , third （T4） , and seventh （T5） day after operation, for counting white blood cell （WBC）, neutrophils and lymphocytes; percentage of T lymphocytes （CD3^＋ mononuclear cells） and its subsets （CDf and CD8^＋） to calculate CDf/CD8^＋ ratio; and the serum content of immunoglobulins （IgG, IgA, IgM） as well as serum concentration of interleukin-8 （IL-8） and interleukin-10 （IL-10） were assayed. Results Compared with the control group, in the SMI group, WBC and neutrophil count were lower at T2（P 〈0.01 ） ; percentages of CD3^＋ and CD4^＋ lower at T, and T5（P〈0. 05 or P 〈0.01 ） ; percentage of CD8＋ higher at T2 to T5（P 〈0.05 or P 〈 0.01） ; CD4^＋/CD8^＋ ratio lower at T3 to T5（P〈0.05 or P〈0.01 ） ; IgG lower at T2（P〈0.05） ; IgA higher at T3 （P〈0.05）; IgM higher at T3 to T5（P〈0.05）; IL-8 lower at T2 to T4（P〈0.05）; and IL-10 higher at T2（P〈 0.05）. Conclusion Application of SMI in the perioperative period can enhance the humoral immunity and inhibit the cellular immunity after CPB, it could also reduce the systemic inflammatory reaction and improve the prognosis of patients.

关 键 词：生脉注射液 体外循环 T淋巴细胞亚群 免疫球蛋白 白细胞介素 

分 类 号：R26[医药卫生—中医外科学]