Wellhausen S R, Ward R A, Johnson G S, DeVries W C
Division of Nephrology, School of Medicine, University of Louisville, Kentucky 40292.
J Clin Immunol. 1988 Jul;8(4):307-18. doi: 10.1007/BF00916559.
Bacterial infections are a significant complication of long-term total artificial heart implantation. We evaluated the functional capabilities of host defense mechanisms in two patients sustained long-term by a total artificial heart. Although serum complement and polymorphonuclear leukocyte function remained intact, both patients became B and T lymphopenic and there was an initial decrease in the ratio of helper/inducer to suppressor/cytotoxic cells. Histologic examination of their lymphoidal tissue at autopsy further revealed reduced numbers of germinal centers and atrophy of the T lymphocyte-dependent areas. In addition, the reticuloendothelial system was engorged with degenerate erythrocytes. We hypothesize that blockade of the reticuloendothelial system was induced by multiple blood transfusions necessitated by device-associated hemolysis and coagulopathy. This blockade may have led to a progressive loss of content of the antigen-specific lymphoidal elements and, perhaps, to a reduced ability to ingest microbe-antibody complexes.
细菌感染是长期植入全人工心脏的一个重要并发症。我们评估了两名长期依靠全人工心脏维持生命的患者体内宿主防御机制的功能。尽管血清补体和多形核白细胞功能保持完好，但两名患者均出现B淋巴细胞和T淋巴细胞减少，且辅助/诱导细胞与抑制/细胞毒性细胞的比例最初有所下降。尸检时对其淋巴组织进行的组织学检查进一步显示生发中心数量减少以及T淋巴细胞依赖区萎缩。此外，网状内皮系统充满了变性红细胞。我们推测，与装置相关的溶血和凝血病所需的多次输血导致了网状内皮系统的阻滞。这种阻滞可能导致抗原特异性淋巴成分的含量逐渐丧失，或许还导致摄取微生物 - 抗体复合物的能力下降。
