Department of Pediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany.
Cytometry B Clin Cytom. 2011 Jul-Aug;80(4):212-20. doi: 10.1002/cyto.b.20587. Epub 2011 Mar 4.
With the intention to reduce overshooting immune response, glucocorticoids are frequently administered perioperatively in children undergoing open heart surgery. In a retrospective study we investigated extensively the modulation of the humoral and cellular immune response by methylprednisolone (MP).
This study was carried out on blood samples from two groups of children who had undergone surgical correction of atrial or ventricular septal defects, either without (MP⁻, n = 10), or with MP administration (MP+, n = 23, dose median 11 (IQR 10-16) mg kg⁻¹ body weight) before cardiopulmonary bypass (CPB, duration median 42 (IQR 36-65) min). EDTA blood was obtained 24 h preoperatively, after anesthesia, at CPB begin and end, 4, 24, and 48 h after surgery, at discharge and at out-patient follow-up (median 8.2 (IQR 3.3-12.2) months after surgery). Complex blood analysis including clinical chemistry and flow cytometry were performed to monitor humoral immune response, differential blood count, lymphocyte subsets, and the degree of activation of various leukocyte subpopulations.
The patients' postoperative courses and follow-up were uneventful. Release of IL-6 and IL8 was reduced and that of the anti-inflammatory cytokine IL-10 upregulated by MP. Significant increase of circulating neutrophils and monocytes as inflammatory reaction to surgery and CPB contact was detected in both groups. However, invasion of monocytes to the periphery was delayed with MP. CD4+ and CD8+ T-lymphocyte counts were lower with MP treatment. B-lymphocyte count increased significantly after surgery in MP+ but remained constant in MP⁻ group.
MP treatment partially decreased the pro-inflammatory effect of CPB surgery and induced anti-inflammatory effect on the cellular and humoral level.
为了减少免疫反应过度，在接受心脏直视手术的儿童中，经常在围手术期给予糖皮质激素。在一项回顾性研究中，我们广泛研究了甲泼尼龙（MP）对体液和细胞免疫反应的调节作用。
这项研究是在接受心房或室间隔缺损手术修复的两组儿童的血液样本中进行的，一组未接受（MP⁻，n=10），另一组接受 MP 治疗（MP⁺，n=23，剂量中位数为 11（IQR 10-16）mg kg⁻¹体重）。在体外循环（CPB，中位数持续时间 42（IQR 36-65）min）前进行。在术前 24 小时、麻醉后、CPB 开始和结束时、手术后 4、24 和 48 小时、出院时和门诊随访时（中位数 8.2（IQR 3.3-12.2）手术后）采集 EDTA 血样。进行复杂的血液分析，包括临床化学和流式细胞术，以监测体液免疫反应、全血细胞计数、淋巴细胞亚群以及各种白细胞亚群的激活程度。
患者术后过程和随访均无异常。MP 降低了白细胞介素 6 和白细胞介素 8 的释放，上调了抗炎细胞因子白细胞介素 10。两组均检测到手术后和 CPB 接触引起的循环中性粒细胞和单核细胞的显著增加，作为炎症反应。然而，单核细胞向周围的浸润在 MP 治疗下被延迟。MP 治疗后 CD4+和 CD8+T 淋巴细胞计数降低。MP⁻组 B 淋巴细胞计数在手术后显著增加，而 MP⁺组则保持不变。
MP 治疗部分降低了 CPB 手术的促炎作用，并在细胞和体液水平上诱导了抗炎作用。
