Luo Wei, Sun Jing-Jing, Tang Hao, Fu Di, Hu Zhan-Lan, Zhou Hai-Yang, Luo Wan-Jun, Xu Jun-Mei, Li Hui, Dai Ru-Ping
Department of Anesthesiology, The Second XiangYa Hospital, Central South University, Changsha, China.
Department of Cardiovascular Surgery, The Second XiangYa Hospital, Central South University, Changsha, China.
Front Cardiovasc Med. 2021 Nov 12;8:747467. doi: 10.3389/fcvm.2021.747467. eCollection 2021.
Many patients with type A aortic dissection (AAD) show low lymphocyte counts pre-operatively. The present study investigated the prognostic values of lymphopenia and lymphocyte subsets for the postoperative major adverse events (MAEs) in AAD patients undergoing surgery, and explore mechanisms of lymphopenia. We retrospectively analyzed pre-operative lymphocyte counts in 295 AAD patients treated at two hospitals, and evaluated their correlation with MAEs. We prospectively recruited 40 AAD patients and 20 sex- and age-matched healthy donors (HDs), and evaluated lymphocyte subsets, apoptosis, and pyroptosis by flow cytometry. Multivariable regression analysis of the retrospective cohort revealed pre-operative lymphopenia as a strong predictor of MAEs (odds ratio, 4.152; 95% CI, 2.434-7.081; < 0.001). In the prospective cohort, lymphocyte depletion in the AAD group was mainly due to loss of CD4 and CD8 T cells as compared with HDs (CD4 T cells: 346.7 ± 183.6 vs. 659.0 ± 214.6 cells/μl, < 0.0001; CD8 T cells: 219.5 ± 178.4 vs. 354.4 ± 121.8 cells/μl, = 0.0036). The apoptosis rates of CD4 and CD8 T cells were significantly higher in AAD patients relative to HDs (both < 0.0001). Furthermore, the pre-operative CD4 T cells count at a cut-off value of 357.96 cells/μl was an effective and reliable predictor of MAEs (area under ROC curve = 0.817; 95% CI, 0.684-0.950; sensitivity, 74%; specificity, 81%; < 0.005). Pre-operative lymphopenia, mainly due to CD4 T cells exhaustion by apoptosis, correlates with poor prognosis in AAD patients undergoing surgery. Pre-operative lymphopenia in particular CD4 T lymphopenia via apoptosis correlates with poor prognosis in AAD patients undergoing surgery.
许多A型主动脉夹层（AAD）患者术前淋巴细胞计数较低。本研究调查了淋巴细胞减少和淋巴细胞亚群对接受手术的AAD患者术后主要不良事件（MAE）的预后价值，并探讨淋巴细胞减少的机制。我们回顾性分析了两家医院治疗的295例AAD患者的术前淋巴细胞计数，并评估了它们与MAE的相关性。我们前瞻性招募了40例AAD患者和20例性别和年龄匹配的健康供者（HD），并通过流式细胞术评估淋巴细胞亚群、凋亡和焦亡。回顾性队列的多变量回归分析显示术前淋巴细胞减少是MAE的有力预测指标（优势比，4.152；95%CI，2.434 - 7.081；P < 0.001）。在前瞻性队列中，与HD相比，AAD组的淋巴细胞耗竭主要是由于CD4和CD8 T细胞的减少（CD4 T细胞：346.7 ± 183.6对659.0 ± 214.6细胞/μl，P < 0.0001；CD8 T细胞：219.5 ± 178.4对354.4 ± 121.8细胞/μl，P = 0.0036）。AAD患者中CD4和CD8 T细胞的凋亡率显著高于HD（均P < 0.0001）。此外，术前CD4 T细胞计数截断值为357.96细胞/μl是MAE的有效且可靠的预测指标（ROC曲线下面积 = 0.817；95%CI，0.684 - 0.950；敏感性，74%；特异性，81%；P < 0.005）。术前淋巴细胞减少，主要是由于凋亡导致的CD4 T细胞耗竭，与接受手术的AAD患者预后不良相关。术前淋巴细胞减少，特别是通过凋亡导致的CD4 T淋巴细胞减少，与接受手术的AAD患者预后不良相关。
