Katoh J, Tsuchiya K, Osawa H, Sato W, Matsumura G, Iida Y, Suzuki S, Hosaka S, Yoshii S, Tada Y
Second Department of Surgery, Yamanashi Medical University, Japan.
J Thorac Cardiovasc Surg. 1998 Aug;116(2):312-8. doi: 10.1016/s0022-5223(98)70132-1.
Depressive effects of cardiopulmonary bypass on cell-mediated immune responses may lead to postoperative infectious complications. We previously reported that cimetidine reduced postbypass depression of the cytotoxic activity of natural killer cells. This study evaluated cimetidine as an agent to preserve cellular immunity after cardiac operations.
In a prospective randomized study, 20 patients were divided into two groups of equal size. Cimetidine-group patients received 400 mg of cimetidine intravenously before bypass and a 33 mg/hr intravenous infusion of cimetidine after the operation, continuing until the fifth postoperative day. Control-group patients received conventional perioperative therapy. Lymphocyte subsets, natural killer cell activity, percentage of CD56+CD16+ (percentage of natural killer cells), and percentage of CD11b+CD8+ (percentage of suppressor T lymphocytes) were measured perioperatively.
Although temporary postoperative reductions in percentages of CD3+, CD4+, and CD56+CD16+ cells were observed in both groups, CD8+ percentages on postoperative day 1 and CD11b+CD8+ percentages on postoperative days 1 and 3 in the cimetidine group were significantly lower compared with those in the control group (p = 0.01,p = 0.004, andp = 0.02, respectively). Temporary postoperative reduction of natural killer cell activity was also observed in both groups, but the natural killer cell activity on postoperative day 1 in the cimetidine group (17.1%) was significantly higher (p = 0.02) than that in the control group (8.20%).
Cimetidine counteracts depressive effects of cardiopulmonary bypass on cell-mediated immunity and may possibly reduce postoperative susceptibility to infection.
体外循环对细胞介导的免疫反应的抑制作用可能导致术后感染并发症。我们之前报道过西咪替丁可减轻体外循环后自然杀伤细胞细胞毒性活性的降低。本研究评估西咪替丁作为一种在心脏手术后维持细胞免疫的药物。
在一项前瞻性随机研究中，20例患者被分为两组，每组人数相等。西咪替丁组患者在体外循环前静脉注射400mg西咪替丁，术后静脉输注西咪替丁33mg/hr，持续至术后第5天。对照组患者接受常规围手术期治疗。围手术期测量淋巴细胞亚群、自然杀伤细胞活性、CD56+CD16+百分比（自然杀伤细胞百分比）和CD11b+CD8+百分比（抑制性T淋巴细胞百分比）。
虽然两组术后均观察到CD3+、CD4+和CD56+CD16+细胞百分比暂时降低，但西咪替丁组术后第1天的CD8+百分比以及术后第1天和第3天的CD11b+CD8+百分比均显著低于对照组（分别为p = 0.01、p = 0.004和p = 0.02）。两组术后也均观察到自然杀伤细胞活性暂时降低，但西咪替丁组术后第1天的自然杀伤细胞活性（17.1%）显著高于对照组（8.20%）（p = 0.02）。
西咪替丁可抵消体外循环对细胞介导免疫的抑制作用，并可能降低术后感染易感性。
