体外循环对小儿VSD患者外周血T细胞亚群和单个核细胞AgNORs的影响  

Effects of extracorporeal circulation on the T lymphocyte cell subsets and AgNORs of mononuclear immune cells in infants with ventricular septal defect

作　　者：杨永辉[1] 刘延芹[2] 张隆[3] 赵砚丽[3] 吕娜[2] 纪惠娟[2] 

机构地区：[1]河北省胸科医院,石家庄市050041 [2]河北省儿童医院 [3]河北省人民医院

出　　处：《河北医药》2010年第22期3112-3115,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划青年基金课题(编号:05139)

摘　　要：目的系统探讨小儿室间隔缺损(ventricular septal defect,VSD)患者体外循环(extracorporeal circulation,ECC)前后T细胞亚群的比例和单个核细胞核仁组成区(nucleoar organizer regions,NORs)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测定32例行VSD修补术的患儿静脉血标本5个时间点的T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,成熟T淋巴细胞(CD3+细胞)及Th细胞(辅助性/诱导性T淋巴细胞,CD4+细胞)在停ECC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[(46±6)%与(21.5±4.0)%],术后第3天时回升,术后第7天时恢复至麻醉诱导后水平(P>0.05);Th/Tc(抑制性/细胞毒性T淋巴细胞,CD8+细胞)比值在术后第1天时显著降低至(1.34±0.38)(P<0.01),术后第3天即恢复到麻醉诱导后水平(P>0.05);Tc细胞和单个核细胞AgNORs无显著变化(P>0.05)。结论 T淋巴细胞总数、Th细胞的比例变化和Th/Tc比值变化有可能作为评价ECC后小儿VSD患者细胞免疫功能受抑制的重要指标;在单个核细胞AgNORs功能不受影响的前提下,于ECC前后应积极采取有效措施改善患儿T淋巴细胞免疫功能状态,增加抗感染能力,减少VSD小儿围ECC期并发症的发生。Objective To investigate the changes of T lymphocyte cell subsets and AgNORs of mononuclear immune cells before and after extracorporeal circulation （ECC） in infants with ventricular septal defect （VSD） who underwent ventricular septal defect repair. Methods The percentage of T lymphocyte cell subsets and the number of AgNORs of mononuclear immune cells at 5 different time points in the peripheral venous blood samples of 32 infants with VSD who underwent ventricular septal defect repair with ECC were detected by immunohistochemistry and histochemistry staining. Results As compared with those after anesthesia, the CD3＋ cells and Th cells （ CD4＋ cells） were significantly decreased immediately at ECC （ P 〈 0. 05 ）, which were obviously decreased at the 1st day and the 3rd day after the operation（ P 〈0.01 ） ,which were the lowest at the 1st day after the operation [ （46 ± 6 ） % and （ 21 ± 4 ） % ], however, which began to increase at the 3rd day after operation, which recovered to the levels after anesthesia induction at the 7th day after operation （ P 〉 0.05 ）. The ratio of Th/ Tc was significantly decreased by 1.34 ± 0. 38 at the first day after the operation （ P 〈 0.01 ）, however,which recovered to the levels after anesthesia induction at the 3rd day after operation （ P 〉 0.05 ）. But there were no significant changes for T lymphocyte cell subsets and AgNORs of mononuclear immune cells （ P 〉 0.05 ）. Conclusion The changes of T lymphocyte cell number, Th cells proportion and the ration of Th/Tc may be used as the important indexes for evaluating the inhibitory state of cellular immunity function in infants with VCD after ECC. Under the precondition of the function of AgNORs of mononuclear immune cells being not affected,the effective measures should be taken to improve patients＇ cellular immunity function, enhance patients＇ anti-infection ability and decrease the occurrence of complications during ECC.

关 键 词：体外循环 室间隔缺损 T 细胞 AGNORS 

分 类 号：R392.32[医药卫生—免疫学]