Section of Cardiac Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.
Division of Allergy, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.
J Thorac Cardiovasc Surg. 2014 May;147(5):1587-1593.e1. doi: 10.1016/j.jtcvs.2013.07.040. Epub 2013 Sep 12.
Hypogammaglobulinemia has been reported after cardiac surgery and may be associated with adverse outcomes. We sought to define baseline immunoglobulin (Ig) concentration in neonates and infants with congenital heart disease, determine their course after cardiopulmonary bypass (CPB), and determine if post-CPB hypogammaglobulinemia was associated with increased morbidity.
This was a single-center, retrospective analysis of infants who underwent cardiac surgery with CPB between June 2010 and December 2011. The Ig concentration was obtained from banked plasma of 47 patients from a prior study (pre-CPB, immediately post-CPB, and 24 and 48 hours post-CPB). In addition, any Ig levels drawn for clinical purposes after CPB were included. Ig levels were excluded if drawn after chylothorax diagnosis or intravenous IgG administration.
The median age was 7 days. Preoperative Ig concentration was similar to that described in healthy children. IgG level decreased to less than 50% of preoperative concentration by 24-hour post-CPB and failed to recover by 7 days. Of 47 patients, 25 (53%) had low IgG (<248 mg/dL) after CPB. Despite no difference in demographics or risk factors between patients with low and normal IgG, low IgG patients had more positive fluid balance at 24 hours and increased proinflammatory plasma cytokine levels, duration of mechanical ventilation, and cardiac intensive care unit length of stay. In addition, low IgG patients had an increased incidence of postoperative infections (40% vs 14%; P = .056).
Hypogammaglobulinemia occurs in half of infants after CPB. Its association with fluid overload and increased inflammatory cytokines suggests it may result from capillary leak. Postoperative hypogammaglobulinemia is associated with increased morbidity, including more secondary infections.
心脏手术后会出现低丙种球蛋白血症，且可能与不良结局相关。我们旨在明确先天性心脏病患儿的基础免疫球蛋白（Ig）浓度，确定其体外循环（CPB）后的变化，并确定 CPB 后低丙种球蛋白血症是否与发病率增加相关。
这是一项单中心、回顾性分析，纳入了 2010 年 6 月至 2011 年 12 月期间行 CPB 心脏手术的婴儿。从之前研究的 47 例患儿的存血浆中获取 Ig 浓度（CPB 前、CPB 后即刻，以及 CPB 后 24 小时和 48 小时）。此外，还纳入了 CPB 后出于临床目的而抽取的任何 Ig 水平。如果在乳糜胸诊断或静脉注射 IgG 后抽取了 Ig 水平，则予以排除。
患儿的中位年龄为 7 天。术前 Ig 浓度与健康儿童相似。CPB 后 24 小时 IgG 水平降至术前浓度的 50%以下，7 天内未恢复。47 例患儿中，25 例（53%）CPB 后 IgG 水平低（<248mg/dL）。尽管低 IgG 组与正常 IgG 组患儿的人口统计学和危险因素无差异，但低 IgG 患儿在 24 小时时具有更多的正液体平衡，且促炎血浆细胞因子水平、机械通气时间和心脏重症监护病房住院时间更长。此外，低 IgG 患儿术后感染的发生率更高（40% vs. 14%；P=0.056）。
CPB 后一半的婴儿会出现低丙种球蛋白血症。其与液体超负荷和促炎细胞因子增加相关，提示其可能由毛细血管渗漏引起。术后低丙种球蛋白血症与发病率增加相关，包括更多的继发感染。
