体外循环手术对红细胞CD35、CD59及T淋巴细胞免疫影响.doc

体外循环手术对红细胞CD35、CD59及T淋巴细胞免疫影响 　 作者：胡金川,田亚平,李佳春,董培青,万彩红,谷 峰,骆 荩,高艳红,江朝光 【摘要】 目的 探讨体外循环(extracorporeal circulation,ECC)手术对红细胞CD35、CD59及T淋巴细胞免疫功能的影响。 方法 选择ECC手术病例18例，于转机前、体温最低点、转机末和术后1 d、3 d、7 d晨采集患者静脉血，测定红细胞CD35、CD59，以及T淋巴细胞CD3、CD4和CD8。 结果 ECC前至ECC末，CD35+红细胞(CD35+-E)百分率、CD59几何平均荧光强度比值(CD59-GMFIR)和CD35-GMFIR均逐渐降低，前二者在术后1 d至7 d逐渐回升，而CD35-GMFIR未见明显恢复趋势。ECC末、术后1 d时CD35+-E百分率和CD35-GMFIR，以及体温最低点、ECC末和术后1 d时CD59-GMFIR均显著低于ECC前(P<0.01或P<0.05)。至术后7 d时，CD35+-E百分率、CD35-GMFIR和CD59-GMFIR仍未恢复至ECC前水平。从ECC前至术后7 d，CD3+ T淋巴细胞(CD3+-T)百分率、CD3+CD4+-T百分率和CD4+-T/CD8+-T比值均呈现先降低后升高的趋势，体温最低点、ECC末、术后1 d和术后3 d的CD3+-T百分率、CD3+CD4+-T百分率均显著低于ECC前(P<0.01或P<0.05)，至术后7 d恢复至接近于ECC前水平，而CD4+-T/CD8+-T比值则恢复至超过ECC前水平。 结论 ECC手术使红细胞CD35、CD59及T淋巴细胞免疫功能下降，后者于术后7 d恢复，前者恢复期长于后者。 【关键词】 体外循环；红细胞免疫；CD35抗原；CD59抗原；T淋巴细胞 CD59 of erythrocytes, and T lymphocytes immune. METHODS Eighteen cases of heart operation under ECC were included in this study. Venous blood samples were collected at pre-ECC, time of minimum body temperature, end of ECC, and 1 day, 3 days, 7 days after operation, then CD35 and CD59 on erythrocytes, and CD3, CD4 and CD8 on T lymphocytes were measured by flow cytometry immediately. RESULTS The CD35 positive erythrocytes(CD35+-E) percentage, geometric mean fluorescence intensity ratio of CD59(CD59-GMFIR) and CD35-GMFIR at time of minimum body temperature and end of ECC decreased, and the former two turned to recover to the level at pre-ECC, while CD35-GMFIR didn’t have the same trend. CD35+-E percentage, CD35-GMFIR at end of ECC and 1 day after operation, and also CD59-GMFIR at time of minimum body temperature, end of ECC and 1 day after operation were lower than those at pre-ECC(P<0.01 or P<0.05), and all the indexes didn’t return to the level at pre-ECC until 7 days after operation. The percentages of CD3 positive T lymphocytes(CD3+-T) and CD3+CD4+-T, and the ratio of CD4+-T/CD8+-T showed similar tendency as the indexes of red-cell immune from pre-ECC to 7 days after operation. The p