CAJ | 학술논문

目的比较深、浅低温体外循环（ CPB）手术对人红细胞（ RBC）、T淋巴细胞免疫影响的差异。方法选择行CPB辅助心脏手术患者18例（深低温7例，浅低温11例），分别于手术前后采集患者静脉血，采用流式细胞仪检测RBC 表面补体受体1（ CR1）、白细胞分化抗原59（ CD59）分子及T 细胞亚群水平。结果深低温CPB患者体温最低点、CPB末时RBC计数较CPB前显著降低（分别P＜0.01、P＜0.05），而术后3 d、7 d时RBC计数显著增高（分别P＜0.05、P＜0.01）；浅低温CPB患者体温最低点、CPB末时RBC计数显著降低（ P＜0.01），而术后7 d时RBC计数显著增高（ P＜0.01）；体温最低点、CPB末、术后1 d、3 d时CR1-GMFIR显著降低（分别P＜0.05、P＜0.01、P＜0.01、P＜0.05）。从CPB末开始至术后7 d，各指标均快速回升；术后3～7 d，深低温CPB患者各指标恢复程度均大于浅低温CPB；术后7 d时，深低温CPB组各指标均恢复至达到或超过CPB前水平，而浅低温CPB组CR1-GMFIR远未恢复至CPB前水平。与CPB前比较，深低温CPB患者体温最低点、CPB末、术后1 d、术后3 d时CD3＋-T细胞百分比和CD4＋-T细胞百分比以及体温最低点、CPB末时CD4＋-T/CD8＋-T比值均显著降低（ P＜0.05或P＜0.01）；浅低温CPB患者CPB末和术后7 d时LYM计数显著升高（分别P＜0.01、P＜0.05），而术后1 d时显著降低（ P＜0.05）；体温最低点、CPB末、术后1 d时CD3＋-T细胞百分比和CD4＋-T细胞百分比以及术后3 d时CD3＋-T细胞百分比均显著降低（ P＜0.05或P＜0.01）。 CPB末时，浅低温CPB患者淋巴细胞计数较CPB前大幅增加，而深低温CPB患者轻度下降；术后1 d至术后7 d，浅低温CPB患者淋巴细胞计数、CD3＋-T细胞百分比和CD4＋-T/CD8＋-T比值均快速上升；术后7 d时，浅低温CPB组CD3＋-T细胞百分比和CD4＋-T/CD8＋-T比值均明显高于深低温CPB组，仅深、浅低温CPB组淋巴细胞计数以及浅低温CPB组CD4＋-T/CD8＋-T比值恢复并且超过CPB前水平。结论深低温CPB手术对RBC免疫有轻度损害，对T细胞免疫有重度损害；而浅低温CPB手术对RBC免疫损害较重，对T细胞免疫损害较轻。目的比較深、淺低溫體外循環（ CPB）手術對人紅細胞（ RBC）、T淋巴細胞免疫影響的差異。方法選擇行CPB輔助心髒手術患者18例（深低溫7例，淺低溫11例），分彆于手術前後採集患者靜脈血，採用流式細胞儀檢測RBC 錶麵補體受體1（ CR1）、白細胞分化抗原59（ CD59）分子及T 細胞亞群水平。結果深低溫CPB患者體溫最低點、CPB末時RBC計數較CPB前顯著降低（分彆P＜0.01、P＜0.05），而術後3 d、7 d時RBC計數顯著增高（分彆P＜0.05、P＜0.01）；淺低溫CPB患者體溫最低點、CPB末時RBC計數顯著降低（ P＜0.01），而術後7 d時RBC計數顯著增高（ P＜0.01）；體溫最低點、CPB末、術後1 d、3 d時CR1-GMFIR顯著降低（分彆P＜0.05、P＜0.01、P＜0.01、P＜0.05）。從CPB末開始至術後7 d，各指標均快速迴升；術後3～7 d，深低溫CPB患者各指標恢複程度均大于淺低溫CPB；術後7 d時，深低溫CPB組各指標均恢複至達到或超過CPB前水平，而淺低溫CPB組CR1-GMFIR遠未恢複至CPB前水平。與CPB前比較，深低溫CPB患者體溫最低點、CPB末、術後1 d、術後3 d時CD3＋-T細胞百分比和CD4＋-T細胞百分比以及體溫最低點、CPB末時CD4＋-T/CD8＋-T比值均顯著降低（ P＜0.05或P＜0.01）；淺低溫CPB患者CPB末和術後7 d時LYM計數顯著升高（分彆P＜0.01、P＜0.05），而術後1 d時顯著降低（ P＜0.05）；體溫最低點、CPB末、術後1 d時CD3＋-T細胞百分比和CD4＋-T細胞百分比以及術後3 d時CD3＋-T細胞百分比均顯著降低（ P＜0.05或P＜0.01）。 CPB末時，淺低溫CPB患者淋巴細胞計數較CPB前大幅增加，而深低溫CPB患者輕度下降；術後1 d至術後7 d，淺低溫CPB患者淋巴細胞計數、CD3＋-T細胞百分比和CD4＋-T/CD8＋-T比值均快速上升；術後7 d時，淺低溫CPB組CD3＋-T細胞百分比和CD4＋-T/CD8＋-T比值均明顯高于深低溫CPB組，僅深、淺低溫CPB組淋巴細胞計數以及淺低溫CPB組CD4＋-T/CD8＋-T比值恢複併且超過CPB前水平。結論深低溫CPB手術對RBC免疫有輕度損害，對T細胞免疫有重度損害；而淺低溫CPB手術對RBC免疫損害較重，對T細胞免疫損害較輕。
목적비교심、천저온체외순배（ CPB）수술대인홍세포（ RBC）、T림파세포면역영향적차이。방법선택행CPB보조심장수술환자18례（심저온7례，천저온11례），분별우수술전후채집환자정맥혈，채용류식세포의검측RBC 표면보체수체1（ CR1）、백세포분화항원59（ CD59）분자급T 세포아군수평。결과심저온CPB환자체온최저점、CPB말시RBC계수교CPB전현저강저（분별P＜0.01、P＜0.05），이술후3 d、7 d시RBC계수현저증고（분별P＜0.05、P＜0.01）；천저온CPB환자체온최저점、CPB말시RBC계수현저강저（ P＜0.01），이술후7 d시RBC계수현저증고（ P＜0.01）；체온최저점、CPB말、술후1 d、3 d시CR1-GMFIR현저강저（분별P＜0.05、P＜0.01、P＜0.01、P＜0.05）。종CPB말개시지술후7 d，각지표균쾌속회승；술후3～7 d，심저온CPB환자각지표회복정도균대우천저온CPB；술후7 d시，심저온CPB조각지표균회복지체도혹초과CPB전수평，이천저온CPB조CR1-GMFIR원미회복지CPB전수평。여CPB전비교，심저온CPB환자체온최저점、CPB말、술후1 d、술후3 d시CD3＋-T세포백분비화CD4＋-T세포백분비이급체온최저점、CPB말시CD4＋-T/CD8＋-T비치균현저강저（ P＜0.05혹P＜0.01）；천저온CPB환자CPB말화술후7 d시LYM계수현저승고（분별P＜0.01、P＜0.05），이술후1 d시현저강저（ P＜0.05）；체온최저점、CPB말、술후1 d시CD3＋-T세포백분비화CD4＋-T세포백분비이급술후3 d시CD3＋-T세포백분비균현저강저（ P＜0.05혹P＜0.01）。 CPB말시，천저온CPB환자림파세포계수교CPB전대폭증가，이심저온CPB환자경도하강；술후1 d지술후7 d，천저온CPB환자림파세포계수、CD3＋-T세포백분비화CD4＋-T/CD8＋-T비치균쾌속상승；술후7 d시，천저온CPB조CD3＋-T세포백분비화CD4＋-T/CD8＋-T비치균명현고우심저온CPB조，부심、천저온CPB조림파세포계수이급천저온CPB조CD4＋-T/CD8＋-T비치회복병차초과CPB전수평。결론심저온CPB수술대RBC면역유경도손해，대T세포면역유중도손해；이천저온CPB수술대RBC면역손해교중，대T세포면역손해교경。
Objective To compare the effects of heart operations under profound and mild hypothermal cardiopulmonary bypass on erythrocyte and T lymphocyte immune .Methods Eighteen cases of patients with heart operations under hypothermal cardiopulmonary bypass were included in this study .Venous blood samples were drawn from patients at pre-and post-operation under CPB , and then complement receptor type 1 ( CR1 ) and cluster differentiation antigen 59(CD59)on erythrocytes and CD3,CD4 and CD8 on T lymphocytes were measured by flow cytometer immediately .Results RBC counts of patients with operation under profound hypothermal CPB at the time of minimum body temperature and post-CPB were significantly less than that of pre-CPB ( P<0.01 and P<0.05 , respectively ) ,while RBC counts on the third and seventh day after operation increased ( P<0.05 and P<0.01 , respectively ) .RBC counts of patients with operation under mild hypothermal CPB at the time of minimum body temperature and post-CPB were significantly less than that of pre-CPB( P<0.01 ) ,while RBC counts on the seventh day after operation increased(P<0.01),and CR1-GMFIR at the time of minimum body temperature ,post-CPB,1 day and 3 days after operation decreased significantly ( P<0.05 ,P<0.01 ,P<0.01 and P<0.05 ,respectively ) .All the researched indexes recovered quickly from post-CPB to the seventh day after operation ,but their recovery degree in patients with profound hypothermal CPB was bigger than that in patients with mild hypothermal CPB ,and on the seventh day after operation ,the indexes in profound hypothermal CPB group reached or exceeded those at the time of pre-CPB,while the CR1-GMFIR level of mild hypothermal CPB group was far away from that at the time of pre-CPB. When compared with the pre-CPB,the CD3 +-T and CD4 +-T percentages of patients with operation under profound hypothermal CPB at the time of minimum body temperature , post-CPB, the first and third day after operation , and CD4 +-T/CD8 +-T ratio at the time of minimum body temperature and post-CPB decreased significantly ( P<0.05 or P<0.01 ) .The lymphocyte counts of patients with operation under mild hypothermal CPB at the time of post -CPB and the seventh day after operation were significantly more than that of pre-CPB ( P <0.01 and P <0.05 , respectively ) , while that on the first day after operation decreased ( P <0.05 ) .And CD3 +-T and CD4 +-T percentages at the time of minimum body temperature , post-CPB and the first day after operation , and CD3 +-T percentage on the third day after operation decreased ( P<0.05 or P<0.01 ) .The lymphocyte count at the time of post-CPB in mild hypothermal CPB group was greatly higher than that of pre-CPB,while that in profound hypothermal CPB group was slightly lower .The lymphocyte count , CD3 +-T percentage and CD 4 +-T/CD8 +-T ratio recovered quickly from the first day to the seventh day after operation .On the seventh day after operation , the CD3 +-T percentage and CD 4 +-T/CD8 +-T ratio in mild hypothermal CPB group were both significantly higher than those in profound hypothermal CPB group ,and only the lymphocyte count in both profound and mild hypothermal CPB group and the CD4 +-T/CD8 +-T ratio in mild hypothermal CPB group recovered and exceeded to the levels at the time of pre-CPB.Conclusions The profound hypothermal CPB impairs erythrocyte immune slightly ,while does severely to T lymphocyte immune .But the mild hypothermal CPB impairs erythrocyte immune severely , while does slightly to T lymphocyte immune .