体外循环对房间隔缺损修补术患儿外周血T细胞亚群和单个核细胞AgNORs的影响  

Effects of Extracorporeal Circulation to Atrial Septal Defect Infants on T Lymphocyte Subsets and AgNORs of Mononuclear Immune Cells

作　　者：杨永辉[1] 刘延芹[2] 张隆[3] 魏文志[4] 吕娜[2] 纪惠娟[2] 

机构地区：[1]河北省胸科医院病理科,石家庄050041 [2]河北省儿童医院麻醉科,石家庄050031 [3]河北省人民医院骨科,石家庄050051 [4]解放军白求恩国际和平医院保健科,石家庄050082

出　　处：《华北国防医药》2010年第5期412-415,共4页Medical Journal of Beijing Military Region

基　　金：河北省医学研究重点课题计划青年基金课题(05139)

摘　　要：目的探究小儿房间隔缺损修补术体外循环(ECC)前后T细胞亚群比例和单个核细胞核仁组成区嗜银蛋白(AgNORs)的变化规律。方法应用免疫组织化学和组织化学染色,分别于麻醉诱导后、停体外循环即刻、术后第1天、术后第3天及术后第7天5个时间点测定36例在体外循环下行房间隔缺损修补术患儿的静脉血标本的T淋巴细胞亚群细胞百分率和单个核细胞AgNORs的数量。结果与麻醉诱导后比较,CD3+细胞、CD4+细胞在停体外循环即刻时降低(P<0.05),术后第1、3天均显著降低(P<0.01),术后第1天降到最低值,术后第3天回升,术后第7天恢复至麻醉诱导后水平(P>0.05);CD4+/CD8+在术后第1天时显著降低(P<0.01),术后第3天即恢复到麻醉诱导后水平(P>0.05);CD8+细胞和单个核细胞AgNORs无显著变化(P>0.05)。结论在单个核细胞AgNORs功能不受影响的前提下,行房间隔缺损修补术患儿体外循环后免疫功能下降,应于体外循环前后积极采取有效措施增强患儿免疫力,以减少围术期并发症,降低病死率。Objective To investigate change patterns of the T lymphocyte subsets proportion and AgNORs of mononuclear cells undergoing atrial septal defect repair with extracorporeal circulation（ECC）in infants.Methods Peripheral venous blood samples of atrial septal defect with ECC in 36 infants were collected to detect the cellular percentage of T lymphocyte subsets and AgNORs with immunohistochemistry and histochemistry staining on five times（after induction of anesthesia,end of ECC,postoperative day 1,postoperative day 3 and postoperative day 7）.Results When compared with the time after induction of anesthesia,the percentage of CD3＋ cells and CD4＋ cells decreased markedly at the end of ECC（P〈0.05）,and obviously lower on postoperative day 1 and postoperative day 3（P〈0.01）.It reached a nadir on postoperative day 1,but returned on postoperative day 3,and increased after induction of anesthesia levels on postoperative day 7（P〈0.05）.The ratio of CD4＋/CD8＋ decreased markedly on postoperative day 1（P〈0.01）and returned to the level of the time after induction of anesthesia on postoperative day 3（P〈0.05）.Changes of CD8＋ and AgNORs were not significant（P〈0.05）.Conclusion When AgNORs function of mononuclear cell is not affected,EEC immune function of infant with atrial septal defect repairment is decreased,so effective measures should be taken before and after EEC to reduce complications and mortality.

关 键 词：房间隔缺损 体外循环 T淋巴细胞 单个核细胞 核仁组成区嗜银蛋白 

分 类 号：R654.1[医药卫生—外科学] R446.6[医药卫生—临床医学]