Platt M P, Lovat P E, Watson J G, Aynsley-Green A
Department of Child Health, Newcastle upon Tyne, England.
J Pediatr Surg. 1989 Sep;24(9):884-7. doi: 10.1016/s0022-3468(89)80588-3.
A study was designed to test the hypothesis that the lymphopenia caused by surgical stress in children may arise through selective depletion of one or more lymphocyte subsets. Blood samples from 22 children were taken pre- and postoperatively and 6, 12, 24, and 48 hours after surgery. Lymphocyte subsets were identified and counted using monoclonal antibodies and indirect immunofluorescence. By six hours postoperatively, the mean total lymphocyte count had fallen by 1.87 x 10(9)/L (P less than .01); this was largely due to the fall in helper T cells (1.53 x 10(9)/L, P less than .01) and both counts remained depressed for at least 48 hours. The helper:suppressor ratio also fell, from 3.42 to 1.92 (P less than .01), but had recovered by 48 hours. Lymphocyte function as measured by the response to pokeweed mitogen and concanavalin A was also reduced six hours postoperatively. These changes were independent of age. Major surgery in infants and children causes a selective reduction in helper T lymphocyte numbers, helper:suppressor ratio, and lymphocyte function. This suggests that immune competence in the immediate postoperative period in children is reduced, as it is in adults. The duration of this and its relationship to infection are not yet known.
儿童手术应激引起的淋巴细胞减少可能是由于一种或多种淋巴细胞亚群的选择性耗竭所致。对22名儿童在术前、术后以及术后6、12、24和48小时采集血样。使用单克隆抗体和间接免疫荧光法鉴定并计数淋巴细胞亚群。术后6小时，淋巴细胞总数均值下降了1.87×10⁹/L（P＜0.01）；这主要是由于辅助性T细胞减少（1.53×10⁹/L，P＜0.01），且这两项计数至少在48小时内持续降低。辅助性T细胞与抑制性T细胞的比例也从3.42降至1.92（P＜0.01），但在48小时时已恢复。术后6小时，通过对商陆有丝分裂原和刀豆球蛋白A的反应所测定的淋巴细胞功能也降低。这些变化与年龄无关。婴幼儿和儿童的大手术会导致辅助性T淋巴细胞数量、辅助性T细胞与抑制性T细胞的比例以及淋巴细胞功能选择性降低。这表明儿童术后即刻的免疫能力如同成人一样会降低。这种情况的持续时间及其与感染的关系尚不清楚。
