Changes in leukocyte subsets: clinical implications for children with chronic renal failure

Increased systemic inflammation and an impaired immune response are features of adult chronic renal failure (CRF). These patients have increased rates of infection, cardiovascular disease, anemia, and malnutrition. We measured inflammatory and immunological markers in a group of children with pre-dialytic CRF. No prior studies have explored these markers even though children with non-dialysed CRF exhibit similar complications to those seen in adults with CRF. Blood was collected from children with mild, moderate, or severe CRF and an age-matched control group. Functional leukocyte subsets were determined using flow cytometry. Circulating levels of interleukin (IL)-1, IL-6, IL-8, IL-12, IL-10, and tumor necrosis factor- were measured using a flow cytometric bead assay. Children with severe CRF showed significantly reduced total white cell count and absolute neutrophil and lymphocyte counts. Absolute numbers of CD3+/CD45RO+ memory T cells and CD3+/CD45RO+/CD62L+ memory Th2 cells were significantly reduced in all CRF groups versus controls. Children with severe CRF showed increased CD11b expression on neutrophils and monocytes. Some patients showed increases in pro-inflammatory cytokines that were not related to their level of residual renal function. As CD11b expression mediates leukocyte adhesion to vascular endothelium, upregulation may contribute to the increased endothelial dysfunction observed in children with CRF. L-selectin mediates extravasation of leukocytes into tissue and homing of peripheral blood lymphocytes to lymph nodes. The reduction in L-selectin may inhibit these actions and predispose patients to increased infection later in life. This is the first study to comprehensively investigate leukocyte functional molecules and inflammatory cytokine profiles in children with pre-dialytic CRF and provides new immunological evidence for the clinical manifestations associated with the disease.     

Are uraemic children immunologically compromised?

BACKGROUND: Various immunological abnormalities leading to impaired immune status have been described in uraemic adults; however, few data are available for uraemic children. METHODS: In this study, peripheral blood total lymphocyte count and lymphocyte subsets (CD3+, CD4+, CD8+, CD16+, CD20+) were evaluated, skin tests with PPD and Candida antigens were performed, and serum immunoglobulin (IgG, IgA, IgM) and complement (C3, C4) levels were measured in 30 children with end-stage renal failure (10 before dialysis, 10 on continuous ambulatory peritoneal dialysis, and 10 on haemodialysis) and the results compared with those of 15 healthy controls. RESULTS: The data showed significant lymphopenia in predialysis and haemodialysis groups. No significant change was observed in the CD4+/CD8+ ratio or in the percentages of lymphocyte subsets in either group studied, while the absolute values of some lymphocyte subsets were significantly lower in all groups as compared with controls. In skin test evaluation, only the patients in the predialysis group showed a significantly decreased response to Candida antigen. The serum immunoglobulin levels were significantly decreased in the continuous ambulatory peritoneal dialysis group as compared with the control group. CONCLUSION: Our results, together with those of other paediatric studies, reported in the literature, suggest that uraemic children are not immunocompromised, though the effects of uraemia may cause some variation in their immune status.     

Acute Ischemia/Reperfusion Injury After Isogeneic Kidney Transplantation Is Mitigated in a Rat Model of Chronic Renal Failure

The influence of chronic renal failure on renal susceptibility to an acute ischemic insult was evaluated. Recipient Lewis rats were randomly assigned to undergo 5/6 nephrectomy (chronic renal failure, CRF) or sham operation (normal renal function, NRF). After 11 weeks, normal kidneys of Lewis donor rats were transplanted in the recipients. The outcome of the isografts was assessed. Filtration capacity of the isografts in the CRF rats was preserved to approximately one-quarter of its normal capacity on the 1st day post-transplantation, whereas it fell to 0 in the NRF rats. This was reflected by a significantly higher increase in serum creatinine in the latter group. The isografts in the CRF rats had a significantly lower degree of acute tubular necrosis and no increase in the number of macrophages and T lymphocytes in the first 24 h in contrast to the NRF rats. Epithelial regeneration and repair started earlier in the CRF group. In conclusion, the present study indicated that CRF blunted ischemia/reperfusion injury of a transplanted kidney, and that its regeneration capacity was certainly not hampered by the presence of chronic uremia. These results will be the basis for studies on modulation of early leukocyte-endothelial interactions resulting from immunological disturbances inherent to the uremic environment.     

体外循环心内直视手术对患者外周血白细胞中性粒细胞T淋巴细胞亚群影响

选择３０例择期心内直视术患者，治疗期间连续观察麻醉前后、术毕、术后第１、７、１４天其外周血白细胞、中性粒细胞、Ｔ淋巴细胞亚群变化，借以判断麻醉与体外转流手术后上述免疫参数变化，为及时防治心内直视术患者术后并发症提供实验依据。结果发现静吸复合麻醉近１ｈ后外周血淋巴细胞数急剧下降，术毕、术后第１至１４天外周血白细胞、中性粒细胞数及其所占百分率显著升高，而淋巴细胞数及其百分率则明显下降。Ｔ淋巴细胞亚群分析发现麻醉后ＣＤ＋３、ＣＤ＋４细胞及ＣＤ＋４／ＣＤ＋８比值明显下降，术毕、术后第１天进一步下降，至术后第７天或１４天恢复至麻醉前水平，这些参数变化是患者术后易并发感染等的原因之一。     

Intracellular cytokines in peripheral blood leucocytes in children with chronic renal failure

We have previously shown that children with mild renal impairment show significant changes in leucocyte subsets and circulating cytokines, indicating that these patients show an increased inflammatory state. We hypothesised that measurement of intracellular cytokine production by lymphocytes and monocytes would more precisely define the immunological mechanism associated with the inflammatory state in children with pre-dialytic chronic renal failure. Blood was collected from children with chronic renal failure (CRF) who were not yet on dialysis and an age-matched control group. Leucocyte subsets and intracellular cytokine production were determined using flow cytometry. Children with CRF showed increased production of interleukin (IL)-12 by monocytes accompanied by decreased production of interferon (IFN)- and increased production of IL-4 by T cells. There were no significant changes in the production of IL-8, IL-10, IL-6, IL-1 or tumour necrosis factor (TNF)- by monocytes or in IL-2 or TNF- production by T cells. There were no significant differences in total white cell count or lymphocyte count. There was a significant decrease in both B and NK cells. This study examines intracellular cytokine production in children with CRF in detail. It is the first to show that children with relatively mild renal failure display significant immunological changes of lymphocyte subsets and leucocyte cytokine production. These data provide a more accurate understanding of the immunological changes that may contribute to the clinical manifestations and progression of the disease.     

A study of the relationship between type of lumbar disc herniation,straight leg raising test and peripheral T lymphocytes

Objective: To observe changes in peripheral T lymphocytes of patients with lumbar disc herniation, and investigate the relationship between the type of herniation, signs and T lymphocyte subsets. Methods: Blood samples from 20 healthy blood donors (control group), and 49 patients (27 male and 22 female) with single‐level lumbar intervertebral disc herniation were collected, the latter preoperatively. T lymphocytes subsets were detected by flow cytometer. According to the position of the intervertebral disc observed during surgery, the patients were divided into ruptured disc herniation (RDH) and degenerative disc herniation (DDH) groups. Straight leg raising (SLR) was assessed preoperatively. Results: Percentages of CD3+, CD4+, and ratio of CD4+/CD8+ in the RDH group were significantly higher, and of percentage of CD8+ significantly lower, than were those in the control group. Percentages of CD4+ and ratio of CD4+/CD8+ were significantly higher, and percentage of CD8+ significantly lower, in the positive SLR test group than were those in the negative SLR test group. The positive rate of SLR testing was significantly higher in the RDH than in the DDH group. Conclusion: Our results suggest that changes in T lymphocyte subsets in peripheral blood take place after herniation of the lumbar intervertebral disc. T lymphocyte mediated immune responses may play an important role in the occurrence and development of signs in patients with herniated lumbar intervertebral discs. The SLR test may help to confirm that disc herniation has caused nerve root impairment by mechanical loading or inflammatory stimulus and provide guidance on the choice of treatment.     

吸入麻醉对T细胞亚群和NK细胞的影响

观察异氟醚和安氟醚吸入麻醉对病人Ｔ细胞亚群、自然杀伤细胞的影响。方法：３８例行肺叶切除术的病人,随机分为异氟醚麻醉组２０例、安氟醚麻醉组１８例。术前、麻醉后１小时,术后１天、术后１周,术后２周分别检测血清Ｔ细胞亚群及ＮＫ细胞活性。结论安氟醚吸入麻醉对病人细胞免疫的抑制作用较异氟醚吸入麻醉明显。     

Effect of lentinan on lymphocyte subsets of peripheral blood,lymph nodes,and tumor tissues in patients with gastric cancer

The effect of lentinan on lymphocyte subsets of peripheral blood, lymph nodes, and tumor tissues in gastric cancer patients was investigated. A 2-mg dose of lentinan was administered to 12 patients intravenously twice, the first at 3–9 days before and the second the day before surgery. The results were then compared with a control group without lentinan administration comprising 12 patients. Regarding peripheral blood and lymph nodes without metastasis, lymphocyte subsets defined with anti-CD3, anti-CD4, anti-CD8, anti-Leu7, and anti-Leu11 were analyzed by flowcytometry. As for tumor tissues, lymphocyte subsets defined with anti-CD3, anti-CD4, anti-CD8, anti-Leu11, and anti-M3 were analyzed after immunohistochemical staining. There were no significant changes in the lymphocyte subsets of peripheral blood between the two groups. In the lymph nodes, the CD4 cell ratios increased; otherwise in regard to tumor-infiltrating lymphocytes (TILs), the number of CD4, Leu11 and LeuM3 cells showed a prominent increase. Therefore, lentinan was observed to produce different effects in accordance with the subjective organs.     

The prognostic value of peripheral blood lymphocyte subsets in patients with bladder carcinoma treated using neoadjuvant M-VEC chemotherapy

OBJECTIVES: To assess the prognostic value of peripheral blood lymphocyte subsets in patients with bladder cancer who were treated with neoadjuvant chemotherapy. PATIENTS, SUBJECTS AND METHODS: Thirty patients with a histological diagnosis of invasive bladder transitional cell carcinoma and 30 age-matched controls with no evidence of cancer and immunological disorders were evaluated. Peripheral blood samples were assessed in both groups using monoclonal antibodies. Patients with bladder cancer who achieved complete or partial responses and those who had progression of the disease after systemic chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin were compared according to the pretreatment values of the peripheral blood lymphocyte subsets. RESULTS: There were no significant differences in B lymphocyte levels between the groups. In patients with bladder cancer, the percentages of T lymphocytes (P<0.01), natural killer (NK) cells (P<0.05) and the CD4+/CD8+ ratio (P<0.05) were significantly lower than in the control group. In patients who responded to the chemotherapy regimen, the pretreatment values of T lymphocytes (P<0.001), the CD4+/CD8+ ratio (P<0.01) and NK cell levels (P<0.01) were significantly higher than in the patients who did not. CONCLUSION: In patients with invasive bladder carcinoma, cell-mediated immunity may have a role in the resistance to this malignancy and in these patients the pretreatment levels of T lymphocyte subsets may be an indicator of the potential response to chemotherapy.     

外周血淋巴细胞亚群监测在甲状腺动脉栓塞治疗Graves病中的意义

目的探讨甲状腺动脉栓塞治疗Graves病（GD）对外周血淋巴细胞亚群的影响。方法对41例临床确诊的Graves病进行甲状腺动脉栓塞治疗,术后随访3～54个月,依据患者症状、体征和甲状腺功能等指标观察疗效。分别于术前、术后1个月、3个月、6个月、12个月及36个月测定外周血淋巴细胞亚群,观察GD患者栓塞治疗前后淋巴细胞的动态变化。结果GD外周血CD3^＋CD8^＋细胞比率减少,CD4^＋/CD8^＋比值增高。CD16^＋CD56^＋细胞于术后1、3个月均高于术前,6个月后降低并接近正常水平;术后CD3^＋CD8^＋细胞逐渐增高,1年后达到正常水平;CD4^＋/CD8^＋比值于治疗6个月后降至正常水平。复发组CD16^＋CD56^＋细胞、CD3^＋CD8^＋细胞比率、CD4^＋/CD8^＋比值与术前比较差异无统计学意义。结论GD患者体内存在免疫功能紊乱,可以检测到外周血淋巴细胞亚群的异常改变。甲状腺动脉栓塞治疗有效者,外周血淋巴细胞亚群的异常得以缓慢纠正,而复发者则无显著改善。说明介入治疗GD可从免疫调节的水平发挥有效的治疗作用,测定外周血淋巴细胞亚群对于判断疗效有一定意义。     

Calcitonin, an important factor in the calcemic response to parathyroid hormone in the rat

The role of calcitonin on the calcemic response to parathyroid hormone (PTH) in renal failure has not been evaluated previously. Often animal studies evaluating the calcemic response to PTH in renal failure are performed in thyroparathyroidectomized (TPTX) animals, and thus eliminate any potential physiologic effect of calcitonin. In addition, parathyroidectomy (PTX), presumably by reduction of high PTH levels, has corrected the calcemic response to PTH in animals with renal failure. The present study was designed to evaluate the effect of endogenous calcitonin production on the calcemic response to PTH in rats with renal failure and secondary hyperparathyroidism, and in rats with normal renal function with diet induced hyperparathyroidism. Four groups of rats were evaluated: 1) chronic renal failure plus TPTX with autotransplant of the parathyroid gland, (CT-) CRF; 2) chronic renal failure plus selective PTX with autotransplant of the parathyroid gland, (CT+) CRF; 3) normal renal function plus TPTX with autotransplant of the parathyroid gland, (CT-) NRF; and 4) normal renal function plus selective PTX with autotransplant of the parathyroid gland, (CT+) NRF. Renal failure was surgically induced by a two-stage 5/6 nephrectomy, and exogenous thyroxine was administered to the two thyroidectomized (CT-) groups. Hyperparathyroidism was induced with a high phosphate diet (1.2%), and thus at the time of PTH infusion, PTH levels were (CT-) CRF 84 +/- 16, (CT+) CRF 89 +/- 21, (CT-) NRF 37 +/- 7, and (CT+) NRF 31 +/- 4 pg/ml, respectively (normal 21 +/- 3 pg/ml). Rat 1-34 PTH (2.6 U/hr) was infused for 48 hours via a subcutaneously implanted Alzet pump.(ABSTRACT TRUNCATED AT 250 WORDS)     

Variation of bronchoalveolar lymphocyte phenotypes with age in the physiologically normal human lung

BACKGROUND: Changes in T lymphocyte subsets have been observed in various forms of pulmonary disease. However, bronchoalveolar lymphocyte subsets have not been well characterised for healthy individuals differing in age. A study was undertaken to investigate the bronchoalveolar lavage (BAL) and peripheral blood lymphocyte subsets in clinically normal volunteers of two different age groups (19-36 and 64-83 years). METHODS: Bronchoalveolar lavage was performed on all individuals in both age groups and peripheral venous blood was drawn just prior to BAL. Bronchoalveolar cell profiles were characterised by morphological criteria, and cell surface antigen expression of lymphocytes was determined by flow cytometry. RESULTS: A significant increase in total BAL lymphocytes was observed for the oldest group compared with the youngest age group. Mean lymphocyte subset (CD4+/CD8+) ratios were significantly increased in BAL fluid from the older group compared with the younger group (mean (SE) 7.6 (1.5) vs 1.9 (0.2); p<0.0001). The increase in the BAL CD4+/CD8+ T cell ratio was mostly due to an increase in relative numbers of CD4+ lymphocytes, and the BAL CD4/CD8 ratio was disproportionately increased compared with peripheral blood in the older group. Increased expression of HLA-DR and CD69 on CD4+ T lymphocytes was observed in the oldest age group. Relative numbers of natural killer (NK) cells did not vary with age, and gammadelta T cells and CD5+ B cells were present in very low numbers in both age groups. CONCLUSIONS: CD4+ T cells accumulate in air spaces of the lower respiratory tract with age in healthy adults and express increased amounts of HLA-DR and CD69 on their surfaces, suggesting a relative degree of CD4+ T lymphocyte activation for healthy older individuals who have normal lung function.     

Effect of mycophenolate mofetil regimen on peripheral blood lymphocyte subsets in kidney transplant recipients

BACKGROUND AND AIMS: There is growing evidence of the effects of immunosuppressive agents on "immune targets" in renal transplantation. Immunological monitoring could indirectly measure the suppressive effect of these drugs and guide early preventive interventions in transplant recipients. Due to the selective antiproliferative effect of mycophenolate mofetil (MMF) on lymphocytes, our goal was to determine whether MMF modulates peripheral blood lymphocyte subsets (PBLS) in kidney allograft patients. METHODS: We assessed absolute CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD19(+), CD16(+)CD3(-) PBLS counts and CD4/CD8 ratios for 12 months in three groups of kidney allograft patients stratified according to maintenance immunosuppressive regimen: group A (n = 31), which started MMF with prednisone (P) + cyclosporine A (CyA), and two control groups, B (n = 19) and C (n = 15) on P + CyA + azathioprine (Aza) and P + CyA regimens, respectively. We compared intra- and intergroup lymphocyte counts and ratios. RESULTS: Intergroup comparisons showed a significant reduction in all PBLS in group A (CD19(+) from 3 months and other subsets from 6 months), whereas there were no significant changes in PBLS in the other group analyses or comparisons. CONCLUSIONS: Our findings suggest that (1) MMF modulates all PBLS in kidney allograft patients, causing a progressive reduction occurring earlier in CD19(+), and (2) we can rule out that these changes were caused by the "natural immunological evolution" of the transplantation. These results could offer a new method for immunological monitoring of transplant patients.     

The effects of neurosurgical stress on peripheral lymphocyte subpopulations

STUDY OBJECTIVE: To observe changes in the peripheral lymphocyte subpopulations as an index of cellular immunity during neurosurgical procedures. DESIGN: Clinical study. SETTING: Operating room of a university hospital. PATIENTS: 11 patients with early intracranial disease who were scheduled to undergo elective neurosurgery with general anesthesia. Patients in the control group (n = 10) underwent minor surgeries such as ophthalmologic, otorhinolaryngological, or orthopedic surgeries. INTERVENTIONS: Blood was sampled before anesthesia induction (t0) for baseline and at 1 hour (t(1)) and 2 hours (t(2)) following surgical incision. MEASUREMENTS: Detection and quantification of lymphocyte subpopulations were performed at each time point using single-label and double-label analyses of monoclonal antibodies against lymphocyte membrane surface markers. MAIN RESULTS: Significant changes in patients who underwent a neurosurgical procedure included: the percentage of total T cells (CD3+) from 57.54 +/- 3.50% at t(0) to 51.41 +/- 4.26% at t(1) and 46.29 +/- 4.02% at t(2); the percentage of inducer T cells (CD4+, Leu8+) from 27.39 +/- 2.26% at t(0), to 23.26 +/- 2.30% at t(1) and 20.82 +/- 2.70% at t(2); the CD4/CD8 ratio, from 1.78 +/- 0.25% at t(0) to 1.35 +/- 0.12% at t(1) and 1.22 +/- 0.17% at t(2). The percentage of suppressor T cells (CD8+, Leu15+) increased significantly from 10.8 +/- 1.07% at t(0) to 13.64 +/- 1.62% at t(1), and 14.82 +/- 1.24% at t(2). The percentages of the natural killer cell subsets also increased significantly. Control group patients who underwent minor surgeries showed no significant changes. CONCLUSIONS: Neurosurgery-induced significant suppression of cellular immunity was demonstrated in peripheral lymphocyte subpopulations, probably from the surgical stress on the central nervous system.     

术中应用右美托咪啶影响结直肠癌患者T淋巴细胞亚群和NK细胞活性的双盲随机临床试验

[摘要]目的观察术中应用右美托咪啶对结直肠癌患者围手术期外周血T淋巴细胞亚群及NK细胞活性的影响。方法选择40例择期结直肠癌手术患者,完全随机双盲分为两组：右美托咪啶组（D）组和对照组（C）组,每组20例。所有患者不用术前药,麻醉诱导前,采用正中人路穿刺法于L1／L2或T12／L1椎间隙置人硬膜外导管。D组：手术前15min静脉注射右美托咪啶1μg／kg,然后以0．5μg／（kg·h）速率持续输注至手术结束前30rain。C组：手术前15min以相同的速率静脉注射等容量的生理盐水。常规麻醉诱导,术后行硬膜外病人自控镇痛。分别于麻醉前（1D）、手术后24h（T1）、手术后48h（他）、手术后72h（T3）抽取静脉血应用流式细胞仪检测外周T淋巴细胞亚群（CD3、CIM、CD8、CD4／CD8）、NK细胞活性。结果①c组CD3、CD4、CIM／CD8在T1至仍点明显下降（P〈0．05）;D组CD3、CIM／CD8在T1点下降明显（P〈0．05）,CD4在T1、r12点下降明显（P〈0．05）;D组患者CD3、CD4、CD4／CD8在T1至T3点明显高于c组（P〈0．05）;CD8在Tl、亿点明显低于c组（P〈0．05）。②C组NK细胞在T1至r13点明显下降（P〈0．05）,D组NK细胞在T1、T2点明显下降（P〈0．05）;D组患者NK细胞在Tl至,13点下降程度不如C组明显（P〈0．05）（P〈0．05）。结论术中应用右美托咪啶,能够减轻围术期结直肠手术患者免疫功能抑制,对术后免疫功能有较好的保护作用。     

不同全麻对口腔恶性肿瘤患者免疫功能的影响

目的 评价不同全麻对口腔恶性肿瘤患者免疫功能的影响.方法 择期拟行口腔恶性肿瘤根治术患者60例,年龄49～64岁,体重50～71kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为3组(n=20):Ⅰ组采用全凭静脉麻醉,静脉注射眯达唑仑、瑞芬太尼、顺阿曲库铵和异丙酚麻醉诱导,静脉输注异丙酚和瑞芬太尼维持麻醉;Ⅱ组采用静吸复合麻醉,麻醉诱导同Ⅰ组,吸入七氟醚或静脉输注异丙酚复合瑞芬太尼维持麻醉;Ⅲ组采用吸入全麻,吸入七氟醚,静脉注射瑞芬太尼和顺阿曲库铵麻醉诱导,吸入七氟醚,静脉输注瑞芬太尼维持麻醉.于麻醉诱导前30 min(T0)、麻醉后1、3、5 h、术毕、术后24、48、72 h(T2～7)时采集外周静脉血,采用流式细胞仪测定T淋巴细胞亚群及NK细胞、B淋巴细胞百分比.结果 与T0时比较,Ⅰ组～Ⅲ组T1-5时CD3+、CD4+、CD4+/CD8+比值、NK细胞百分比和B淋巴细胞百分比降低,Ⅱ组和Ⅲ组T6时CD3+、CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05或0.01);与Ⅰ组比较,Ⅱ组T2,3,6时CD4+、CD4+/CD8+比值和Ⅲ组T2～6时CD3+、CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05或0.01);与Ⅱ组比较,Ⅲ组T4.5时CD4+、CD4+/CD8+比值及NK细胞百分比降低(P＜0.05).结论 与吸人麻醉和静吸复合麻醉比较,咪达唑仑、瑞芬太尼和异丙酚全凭静脉麻醉对口腔恶性肿瘤患者免疫功能的抑制程度较低.

Abstract：

Objective To investigate the effects of different general anesthesia protocols on immune function in patients with oral malignant tumor. Methods Sixty ASA Ⅰ or Ⅱ patients undergoing elective radical operation for oral malignant tumor were randomly divided into 3 groups ( n = 20 each): group Ⅰ total intravenous anesthesia (TIVA); group Ⅱ combined intravenous-inhalational anesthesia (IV-INH) and group Ⅱ inhalational anesthesia (INN). Anesthesia was induced and maintained with propofol and remifentanll in group Ⅰ; with sevoflurane,propofol and remifentanil in group Ⅱ and with sevoflurane and remifentanil in group Ⅲ. Peripheral venous blood samples were taken at 30 min before (To) and 1 h (T1), 3 h (T2 ) and 5 h (T3) after induction of anesthesia, the end of operation (T4 ) and at 24 h (T5 ), 48 h (T6 ) and 72 h (T7) after operation for determination of the percentages of T lymphocyte subsets (CD3+ , CD4+ , CD8+ , CD4+/CD8+ ratio). Natural killer (NK) cells (CD16+ ,CD56+ ) and B lymphocyte (CD19+ ) with flow cytometer. Results The percentages of CD3+ , CD4+ , NK cells, B lymphocyte and CD4+/CD8+ ratio were significantly decreased during and after operation at T1-5 in all groups and the percentges of CD3+ ,CD4+ ,NK cells and CD4+/CD3+ ratio were decreased at T6 in groups Ⅱ and Ⅲ as compared with the baseline values before anesthesia at To. The percentage of CD4+ cells and CD4+/CD8+ratio were significantly lower during anesthesia at T2,3,6 in group Ⅱ than in group Ⅰ . The percentages of CD4 +and NK cells and CD4+/CD8+ ratio were significantly higher after operation at T4,5 in group Ⅱ than in group Ⅲ.The percentages of CD3 + , CD4 + , NK cells and CD4 +/CD8 + ratio were significantly lower at T2-6 in group Ⅲthan in group Ⅰ . Conclusion TIVA with midazolam, propofol and remifentanil has less impact on immune function than inhalational and combined intravenous-inhalational anesthesia in patients with oral malignant tumor under-going elective radical operation.     

微波烘疗调节肢体慢性淋巴水肿免疫的研究

目的　研究局部及全身免疫反应在淋巴水肿患者中的作用特点及微波烘疗对免疫反应的影响。方法　应用碱性磷酸酶抗碱性磷酸酶聚合物 (APAAP)和亲和素 -生物素 -过氧化物酶 (ABC)免疫组织化学法 ,对2 7例慢性肢体淋巴水肿患者微波烘疗前后全身及局部浸润淋巴细胞表型进行检测。结果　淋巴水肿患者有外周血CD4 T淋巴细胞 ,以及 CD4 / CD8 比例的降低和真皮层血管周围 T淋巴细胞浸润 ;经两个疗程的微波烘疗后 ,CD4 T淋巴细胞上升 ,CD4 / CD8 比例恢复正常 ,真皮层小血管周围 T淋巴细胞浸润明显消退。结论　微波烘疗可调节慢性肢体淋巴水肿患者全身及局部免疫失衡。     

Effect of dietary chloride on spontaneously hypertensive rat.

The anionic component of sodium salt has been reported to contribute to hypertension in some animal models and hypertensive patients. In the present study, the anionic effects on exacerbation of hypertension in spontaneously hypertensive rat (SHR) were investigated by chronic loading tests with two sources of sodium, viz. sodium chloride (NaCl; 0.9% solution) and sodium bicarbonate (NaHCO3; 1.28% solution), using SHRs with normal renal function (NRF) and with chronic renal failure (CRF; produced by cryosurgery). In addition, extracellular fluid volume (ECFV: inulin space) was measured in SHRs with NRF and CRF. In the NRF groups, systolic blood pressure (SBP) reached 230 mmHg at Week 13, and there was no significant difference in SBP between the NaCl and NaHCO3 groups. In the CRF groups, SBP of the NaCl group was significantly higher (p less than 0.01) than that of the NaHCO3 group (280 mmHg vs. 230 mmHg at Week 15). ECFV was also greater in the NaCl group than in the NaHCO3 group (ECFV: NaCl vs. NaHCO3, 15.9 +/- 1.7 vs. 14.0 +/- 0.9 at Week 13; and 16.2 +/- 1.1 vs. 14.2 +/- 1.2 at Week 15, respectively). These results indicate that chloride ion plays an important role in the pathogenesis of hypertension in SHR with CRF. Expansion of ECFV is considered to be one of the mechanisms whereby the hypertension is exacerbated.     

Comparative analysis of immunophenotypic abnormalities in cellular immunity of uremic patients undergoing either hemodialysis or continuous ambulatory peritoneal dialysis

AIM: To investigate the abnormalities of cellular immune responses in patients on hemodialysis (HD) and in those on continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS: Forty-five (45) healthy volunteers, 34 patients on HD therapy, and 37 patients on CAPD were recruited for the present study. Lymphocyte subpopulations (CD2+, CD3+, CD3+/CD4+, CD3+/CD8+, CD3-/16+56+, CD19, and CD4/CD8) were determined by flow cytometry. RESULTS: Lymphopenia, decreased absolute counts, and altered percentage values of CD3+, CD3+/ 4+, and CD19+ subpopulations were found in both patient groups. The HD and CAPD patients showed increased percentages of natural killer cells (CD3-/16+56+) compared to controls but CD4+/CD8+ ratio showed no significant changes among uremic patients and controls. CONCLUSIONS: Replacement therapy may contribute to the quantitative alterations of immune subsets found in HD and CAPD patients compared to normal subjects. We speculate that these changes account, at least in part, for the immune dysregulation observed in patients with chronic renal failure. Analysis of lymphocyte subsets will help the research and the evaluation of the possible causes of immunodeficiency in uremic patients undergoing replacement therapy and will probably contribute to more efficient and preventive strategies.     

不同全麻下腹腔镜结肠癌切除术病人围术期细胞免疫功能的比较

目的 比较在相同麻醉深度下不同全麻对腹腔镜结肠癌切除术病人围术期细胞免疫功能的影响.方法 择期行腹腔镜结肠癌切除术的病人90例,年龄40～64岁,体重50～85 kg,性别不限,ASA分级Ⅰ或Ⅱ级.采用分层随机法,将患者随机分为3组(n＝30):全凭静脉麻醉组(Ⅰ组)、吸入全麻组(Ⅱ组)和静吸复合全麻组(Ⅲ组).Ⅰ组静脉注射咪达唑仑、舒芬太尼和维库溴铵,TCI异丙酚和瑞芬太尼麻醉诱导;TCI异丙酚和瑞芬太尼,间断静脉注射维库溴铵维持麻醉.Ⅱ组吸入七氟醚麻醉诱导,吸人七氟醚,间断静脉注射维库溴铵维持麻醉.Ⅲ组静脉注射咪达唑仑、舒芬太尼和维库溴铵,TCI异丙酚和瑞芬太尼麻醉诱导,TCI异丙酚和瑞芬太尼,吸入七氟醚,间断静脉注射维库溴铵维持麻醉.术中采用Narcotrend指数监测麻醉深度,维持Narcotrend指数37 ～ 64.于麻醉诱导前30min(T0)、切皮后2 h(T1)、术毕(T2)和术后24 h(T3)时采外周静脉血样,采用流式细胞术测定T淋巴亚群CD3+、CD4+、CD8+和NK细胞的水平,计算CD4+/CD8+.结果 与T0时比较,Ⅱ组T2时CD3+、CD4+、CD4+/CD8+和NK细胞水平降低,Ⅲ组T2时NK细胞水平降低(P<0.05);与Ⅰ组比较,T2时Ⅱ组CD3+、CD4+、CD4+/CD8+和NK细胞水平降低,Ⅲ组NK细胞水平降低(P＜0.05);与Ⅲ组比较,T2时Ⅱ组CD3+和CD4+水平降低(P<0.05).结论 与吸入麻醉和静吸复合麻醉比较,静脉注射咪达唑仑、舒芬太尼和维库溴铵,TCI异丙酚和瑞芬太尼麻醉诱导,TCI异丙酚和瑞芬太尼,间断静脉注射维库溴铵维持麻醉对腹腔镜结肠癌切除术病人围术期细胞免疫功能的抑制程度低.