Hisatomi K, Isomura T, Hirano A, Yasunaga H, Sato T, Hayashida N, Ohishi K, Toshima H
Second Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan.
J Thorac Cardiovasc Surg. 1992 Sep;104(3):648-53.
Erythroderma as a manifestation of graft-versus-host disease after cardiac operations with blood transfusion may occur more frequently in Japan than in other countries. We have seen this problem in five patients who, after heart operations, died with symptoms and signs characteristic of graft-versus-host disease: cutaneous eruption, fever, diarrhea, leukopenia associated with agranulocytosis, and liver dysfunction. In the three patients seen most recently, skin biopsy showed findings similar to those of graft-versus-host disease after bone marrow transplantation. In addition, immunologic investigation showed remarkable differences in the findings in these patients and in those who did not have a graft-versus-host disease-like syndrome after cardiac operations. In particular, interleukin-2 production in response to mitogen stimulation was markedly diminished after operation in our patients, and the ratio of OKT4+ cells to OKT8+ cells in peripheral blood was low, reflecting increased numbers of OKT8+ cells after the occurrence of symptoms. The results raise the possibility that transient depression of cellular immunity after cardiac operations with blood transfusion may contribute to the occurrence of postoperative acute graft-versus-host disease.
输血心脏手术后，红皮病作为移植物抗宿主病的一种表现，在日本可能比其他国家更常见。我们在5例心脏手术后死亡的患者中发现了这个问题，这些患者具有移植物抗宿主病的症状和体征：皮疹、发热、腹泻、与粒细胞缺乏相关的白细胞减少以及肝功能障碍。在最近见到的3例患者中，皮肤活检显示的结果与骨髓移植后的移植物抗宿主病相似。此外，免疫学调查显示，这些患者与心脏手术后未出现移植物抗宿主病样综合征的患者在结果上存在显著差异。特别是，我们的患者术后对有丝分裂原刺激的白细胞介素-2产生明显减少，外周血中OKT4+细胞与OKT8+细胞的比例较低，反映出症状出现后OKT8+细胞数量增加。这些结果提示，输血心脏手术后细胞免疫的短暂抑制可能导致术后急性移植物抗宿主病的发生。
