体外循环对使用或不使用自体输血装置时淋巴细胞及其亚群计数的影响。

Effects of cardiopulmonary bypass on lymphocytes and their subset counts with or without use of autotransfusion devices.

作者信息

Perttilä J, Salo M, Pirttikangas C O, Jalonen J, Vainio O

机构信息

Department of Anaesthesiology, University of Turku, Finland.

出版信息

J Cardiothorac Vasc Anesth. 1994 Oct;8(5):532-5. doi: 10.1016/1053-0770(94)90165-1.

DOI:10.1016/1053-0770(94)90165-1

PMID:7803741

Abstract

Lymphocytes and their subset counts were determined in 30 cardiac surgery patients during cardiopulmonary bypass (CPB) with or without use of an autotransfusion device. In the autotransfusion group, centrifuged and washed autologous red blood cells (median 400 mL [range 200-770 mL]) and in the control group corresponding amounts of homologous packed red blood cells (median 500 mL [range 250-750 mL]) were transfused after declamping the aorta. The percentages of T lymphocytes (CD3) and T cytotoxic cells (CD8) increased in both groups (CD3 up to 5%, P < 0.05 and CD8 up to 35%, P < 0.01), but the percentage of T helper cells (CD4) did not change. The ratio of CD4/CD8 cells decreased (up to 34%, P < 0.01). The percentage of naive resting T cells (CD45RA) increased slightly (up to 8%, P < 0.05) whereas the percentages of memory T cells (CD45RO), T cells with IL-2 receptor (CD25), and natural killer cells (CD16) remained unaltered. The percentage of HLA-DR positive lymphocytes increased during CPB (up to 18%, P < 0.05), but it was decreased thereafter (up to 16%, P < 0.05). The percentage of monocytes (CD14) decreased first during CPB in both groups (up to 32%, P < 0.01), but it was higher in the autotransfusion device group (decreased 29% from initial value) than in the control group (decreased 65% from initial value) at the end of CPB (P < 0.05). This study shows that extracorporeal circulation has an effect on lymphocytes and their subset counts. The changes were slightly immunosuppressive. By contrast, use of autotransfusion devices had only minor effects.

摘要

在30例接受心肺转流（CPB）的心脏手术患者中，无论是否使用自体输血装置，均对淋巴细胞及其亚群计数进行了测定。在自体输血组，主动脉夹闭解除后输注经离心和洗涤的自体红细胞（中位数400 mL[范围200 - 770 mL]），而在对照组输注相应量的同源浓缩红细胞（中位数500 mL[范围250 - 750 mL]）。两组中T淋巴细胞（CD3）和细胞毒性T细胞（CD8）的百分比均升高（CD3升高至5%，P < 0.05；CD8升高至35%，P < 0.01），但辅助性T细胞（CD4）的百分比未发生变化。CD4/CD8细胞比值降低（高达34%，P < 0.01）。初始静止T细胞（CD45RA）的百分比略有升高（高达8%，P < 0.05），而记忆T细胞（CD45RO）、具有白细胞介素-2受体的T细胞（CD25）和自然杀伤细胞（CD16）的百分比保持不变。CPB期间HLA - DR阳性淋巴细胞的百分比升高（高达18%，P < 0.05），但随后降低（高达16%，P < 0.05）。两组中单核细胞（CD14）的百分比在CPB期间首先降低（高达32%，P < 0.01），但在CPB结束时，自体输血装置组高于对照组（从初始值分别降低29%和65%）（P < 0.05）。本研究表明，体外循环对淋巴细胞及其亚群计数有影响。这些变化具有轻微的免疫抑制作用。相比之下，使用自体输血装置的影响较小。