体外循环期间Th1、Tc1/Th2Tc2细胞亚群与机体致炎/抗炎反应的关系  

The relationship between Th1,Tc1/Th2,Tc2 cell subsets and inflammatory response/anti-inflammatory response during cardiopulmonary bypass

作　　者：倪海峰 肖颖彬[2] NI Hai-feng;XIAO Ying-bin(epartment of Cardiac Surgery,No 150 Hospital of PLA,Luoyang,Henan 471031,China)

机构地区：[1]解放军150医院心胸外科,河南洛阳471031 [2]第三军医大学新桥医院心血管外科,重庆400037

出　　处：《实用医药杂志》2018年第3期207-210,213,共5页Practical Journal of Medicine & Pharmacy

摘　　要：目的研究体外循环(CPB)中Th1、Tc1/Th2、Tc2细胞功能亚群的变化及与机体致炎/抗炎反应的关系。方法随机抽取二尖瓣瓣膜病、先天性动脉导管未闭患者各20例,设为试验组和对照组。于术前、CPB或手术开始20 min、停机前或手术结束时、术后4 h、术后24 h、术后72 h取血,分离T细胞,提取RNA,Northern blot法检测IFN-γ/IL-4mRNA表达;细胞内因子染色检测IFN-γ/IL-4蛋白表达。取血清,放射免疫检测致炎介质IL-6、抗炎介质IL-10水平。结果与术前相比,试验组CPB中IFN-γmRNA蛋白表达水平出现一过性下调,IL-4mRNA、蛋白表达水平出现一过性上调,IL-6、IL-10水平明显升高,差异有统计学意义(P<0.05),分别于术后24 h或72 h恢复到术前水平(P>0.05);对照组各时相点IFN-γ/IL-4mRNA蛋白表达差异无统计学意义(P>0.05);IL-6水平明显升高,差异有统计学意义(P<0.01),术后72 h恢复到术前水平(P>0.05);各时相点IL-10水平差异无统计学意义(P>0.05)。结论 CPB可致Th1、Tc1细胞数量减少、Th2、Tc2细胞数量增加,进而上调机体抗炎反应,抑制致炎反应,失控后可能成为CPB术后并发症的发病基础及影响ICU病死率的重要因素。Objective To study the relationship between Th1,Tc1/Th2,Tc2 and inflammatory response/anti-inflammatory response during cardiopulmonary bypass.Methods The 20 patients with mitral valve disease were selected randomly as trial group,and 20 patients with congenital patent ductus artereriosus as control group.The blood was sampled before operation,20min after the begin of cardiopulmonary bypass or operation,the end of cardiopulmonary bypass or operation,as well 4 hours,24 hours,72 hours after operation,then after separated T lymphocyte and extracted RNA,the expression of IFN-γ/IL-4mRNA and protein were detected by Northern blot and intracellular cytokine staining;serum IL-6 and IL-10 levels were detected by using radioimmunoassay.Results In trial group,the expression of IFN-γmRNA and protein down regulated transiently,the expression of IL-4 mRNA and protein up regulated transiently,while IL-6 and IL-10 level increased obviously during cardiopulmonary bypass than preoperation(P<0.05),and returned to the preoperative levels 24-72hours after operation(P>0.05).In control group,the expression level of IFN-γ/IL-4mRNA and protein,IL-10 did not change obviously(P>0.05),but IL-6 level increased obviously during operation(P<0.05).Conclusion The count of Th1,Tc1 cells decreased and Th2,Tc2 cells increased during cardiopulmonary bypass,which secondaryly cause anti-inflammatory response up-regulated,inflammatory response down-regulated,and may be one of the internal mechanisms of complication and mortality after cardiopulmonary bypass.

关 键 词：体外循环 T细胞 Th1、Tc1 Th2、Tc2细胞功能亚群 IL-4 IFN-γ IL-6 IL-10 

分 类 号：R654.1[医药卫生—外科学]