体外循环心脏瓣膜置换术对老年风湿性心脏病患者左心功能及调节性T细胞的影响  

Effects of heart valve replacement under extracorporeal circulation on left ventricular function and regulatory T cells in elderly patients with rheumatic heart disease

作　　者：周朝元[1] 苏国宝[1] 刘晓晨[1] 李保春 Zhou Chaoyuan;Su Guobao;Liu Xiaochen;Li Baochun(Department of Cardiovascular Surgery,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453199,China)

机构地区：[1]新乡医学院第一附属医院心血管外科,新乡453100

出　　处：《中华老年医学杂志》2022年第12期1473-1477,共5页Chinese Journal of Geriatrics

摘　　要：目的研究体外循环(ECC)心脏瓣膜置换术对老年风湿性心脏病患者左心功能及调节性T细胞的影响。方法回顾性选择2018年9月至2020年9月收治在我院行ECC心脏瓣膜置换术的113例老年风湿性心脏病患者作为受试者。另选取同期113例健康体检者为对照组。观察组患者行ECC心脏瓣膜置换术。比较两组患者左心功能、调节性T细胞结果。结果手术前风湿性心脏病患者左心房横径(LA)较对照组增大[(56.2±9.3)mm和(29.4±3.5)mm,t=28.670,P<0.001];左心室舒张末期内径(LVDD)[(32.4±7.7)mm和(38.4±8.5)mm,t=5.561,P<0.001]、左心室射血分数(LVEF)[(58.4±11.5)%和(65.6±10.5)%,t=4.915,P<0.001]、心排血量(CO)[(3.7±2.6)L/min和(4.7±1.6)L/min,t=3.482,P<0.001]均较对照组降低;体外循环结束后10 min、术后1 d左心功能指标均无明显变化(均P>0.05);术后1个月较术前,肺动脉内径(PA)[(25.2±3.8)mm和(31.2±5.6)mm,t=9.659,P<0.001]及LA[(46.2±7.8)mm和(56.2±9.3)mm,t=8.758,P<0.001]均减小;而右心室舒张末期内径(RVDD)、左心室舒张末期内径(LVDD)变化不明显,同时LVEF、CO、LVFS也无明显变化(均P>0.05)。手术前风湿性心脏病患者的CD25^(+)CD4^(+)T细胞占淋巴细胞的比例、CD4^(+)CD25^(+)Foxp3^(+)Treg细胞占CD4^(+)T细胞的比例均低于对照组(均P<0.01),体外循环结束后10 min、术后第1 d较术前进一步降低,术后第3 d则有所升高,至术后第7 d则升高至术前水平,但仍低于对照组(P<0.05)。结论老年风湿性心脏病患者行体外循环双瓣置换术后,左心房会在短期内缩小,能够恢复三尖瓣反流,减轻损害细胞免疫功能,但其收缩功能未变化。Objective To assess the effects of heart valve replacement under extracorporeal circulation(ECC)on left ventricular function and regulatory T cells in elderly patients with rheumatic heart disease(RHD).Methods 113 elderly patients with rheumatic heart disease receiving ECC heart valve replacement at our hospital from September 2018 to September 2020 were selected retrospectively as subjects.Another 113 healthy people from the same period were selected as the control group.Patients in the observation group received ECC heart valve replacement.Left heart function and regulatory T cells were compared between the two groups.Results Before surgery,the left atrial transverse diameter(LA)of RHD patients was significantly increased compared with the control group[(56.2±9.3)mm vs.(29.4±3.5)mm,t=28.670,P<0.001],and the left ventricular end diastolic diameter(LVDD)[(32.4±7.7)mm vs.(38.4±8.5)mm,t=5.561,P<0.001],left ventricular ejection fraction(LVEF)[(58.4±11.5)%vs.(65.6±10.5)%,t=4.915,P<0.001]and cardiac output(CO)[(3.7±2.6)L/min vs.(4.7±1.6)L/min,t=3.482,P<0.001]were significantly decreased compared with the control group.There were no significant changes in left heart function parameter values 10 min and 1 day after surgery(all P>0.05).One month after surgery,the inner diameter of pulmonary artery(PA)[(25.2±3.8)mm vs.(31.2±5.6)mm,t=9.659,P<0.001]and LA[(46.2±7.8)mm vs.(56.2±9.3)mm,t=8.758,P<0.001]were decreased compared with those before surgery,while changes in right ventricular end diastolic inner diameter(RVDD)and left ventricular end diastolic inner diameter(LVDD)were not significant,and there were no significant differences in LVEF,CO and LVFS(all P>0.05).The proportion of CD25^(+)CD4^(+)T cells in lymphocytes and the proportion of CD4^(+)CD25^(+)Foxp3^(+)Treg cells in CD4^(+)T cells in RHD patients before surgery were significantly lower than those in the control group(P<0.01).The proportions decreased 10 min and 1 day after surgery,but increased 3 days after surgery and returned to preoperative levels

关 键 词：体外循环 心脏 风湿性心脏病 心室功能 左 T淋巴细胞 

分 类 号：R654.2[医药卫生—外科学]