心肺转流下室间隔缺损修补术患儿单个核细胞的变化  

Effects of cardiopulmonary bypass on the changes of mononuclear immune cells in infants undergoing ventricular septal defect repair

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

机构地区：[1]河北省儿童医院麻醉科,石家庄市050031 [2]河北省胸科医院麻醉科 [3]河北省人民医院骨科 [4]河北省人民医院麻醉科

出　　处：《临床麻醉学杂志》2011年第7期635-637,共3页Journal of Clinical Anesthesiology

基　　金：河北省医学研究重点课题计划青年基金课题(05139)

摘　　要：目的探讨室间隔缺损（VSD）患儿心肺转流（CPB）前后单个核细胞的变化。方法CPB下行VSD修补术的患儿32例，分别于麻醉诱导后（T0）、停CPB即刻（T1）、术后第1天（T2）、第3天（T3）及第7天（L）采集静脉血标本，应用流式细胞仪测定CD3＋、CD4＋、CD8＋、CD19＋、CD14＋、CD16＋CD56＋细胞百分率；采用组织化学方法进行核仁组成区嗜银蛋白（AgNORs）染色并在全自动数码显微镜下测定其直径，计算每个细胞核中AgNORs的个数。结果与T0时比较，T1～T3时CD3＋、CD4＋均明显降低（P〈0．05或P〈0．01）；T1时CD19＋、CD14＋明显降低（P〈O．05或P〈O．01），CD16＋CD56＋明显升高（P〈0．01）；T2时CD4＋／CD8＋明显降低（P〈0．01），CD16＋CD56＋仍明显升高（P〈0．01）；T4时仅CD14＋升高（P〈O．05），其它指标均恢复到T0时水平。AgNORs形态类型为单一型，大都呈规则的圆形，CPB前后形态和数量无明显变化。结论单个核细胞的数量减少是细胞免疫功能受抑制的主要因素。Objective To investigate the changes of mononuclear cells in infants undergoing ventricular septal defect repair with cardiopulmonary bypass （CPB）. Methods Peripheral venous blood samples were obtained from 32 infants undergoing atrial septal defect repair with CPB after the induction of anesthesia （T0）, end of CPB （T1） and day 1 （T2）, day 3 （T3） as well as day 7 （T4） after surgery respectively. The percentage of T lymphocyte （TC） subsets including CD3＋., CD4＋ and CD8 ＋ TC, the ratio of CD4＋/CD8＋ TC and CD19 ＋ B-lymphocyte as well as CD14 ＋ monocyte and CD162＋CD56 ＋ natural killer cell were counted with flow cytometry. The number of AgNORs within the nucleus was recorded by microscope. Results Compared with To, the percentage of CD3＋ and CD4＋ cells decreased markedly at T1 to T3 （P〈 0.05 ） ; CD19＋ and CD14 ＋ cells significantly decreased （P〈 0.05 ） while CD16＋ CD56＋ cells significantly increased （P（0.01） at T1 ; One day after surgery, CD4＋/CD82. also markedly decreased while CD162.CD56＋ cells still maintained at a higher level; seven days after surgery, only the percentage of CD14＋ cells still more than that at To, others were retured to the basal level. The modalities of AgNORs were singleness type, present as rotundity mostly and have no significant changes after CPB. Conclusion The decrease of mononuclear immune cell in peripheral blood is one of the key factor in cellular immunosuppression.

关 键 词：心肺转流 室间隔缺损 单个核细胞 流式细胞术 核仁组成区嗜银蛋白 

分 类 号：R726.5[医药卫生—儿科]