小儿体外循环对中性粒细胞CD11/CD18表达水平的影响

目的:观察小儿体外循环(CPB)对中性粒细胞CD 11/CD 18的表达水平,探讨CD 11/CD 18在小儿体外循环诱发的全身炎症反应中的作用。方法:30例房室水平左向右分流型先天性心脏病在CPB下行心内直视手术患儿(CPB组)和20例非CPB胸科或腹部手术患儿(对照组)被纳入本研究对象,于麻醉诱导后、体外循环转流后10~15 m in、体外循环转流结束、术后2 h和术后第1、2、3天取外周静脉血,采用流式细胞术检测外周血中性粒细胞CD 11/CD 18分子表达水平,酶联免疫法(EL ISA)定量测定血浆中IL-6、IL-8水平。结果:CPB组体外循环停机后血浆IL-6、IL-8水平开始升高并于术后2 h达峰值(P<0.05),随后开始下降,但仍高于诱导后水平(P<0.05);对照组血浆IL-6、IL-8水平于术后2 h达峰值(P<0.05),但其变化幅度小于CPB组相应时间点的值。CPB组外周血中性粒细胞CD 11b/CD 18表达水平于转流后10~15 m in明显升高(P<0.05)并达峰值,术后第1、2天低于基础水平(P<0.05),第3天与基础水平比无显著性差异(P>0.05)。对照组外周血中性粒细胞CD 11b/CD 18表达水平在各时间点间无显著性差异(P>0.05)。CPB组和对照组外周血中性粒细胞CD 11a/CD 18、CD 11c/CD 18表达水平于各时间点均无显著性差异(P>0.05)。结论:小儿体外循环可促发外周血中性粒细胞CD 11b/CD 18表达水平增高,而对CD 11a/CD 18和CD 11c/CD 18的表达水平无明显影响,CD 11b/CD 18在小儿体外循环诱发的全身炎症反应中可能发挥重要作用。

Effect of cardiopulmonary bypass on CD11/CD18 expression of neutrophils in children undergoing cardiac surgery

Objective: To investigate the changes in perioperative expression level of CD11/CD18 of neutrophils in children undergoing cardiac surgery with cardiopulmonary bypass(CPB).Methods: Thirty children patients with congenital heart disease underwent cardiac surgery with CPB(CPB group) and the control group consisted of 20 children who received thoracic or general surgery without CPB.Blood samples were drawn at the following time points:pre-surgery,15 min after onset of CPB,immediately after CPB,2 h after surgery and on the 1~(st),2~(nd),3~(rd)postoperative day.D11/CD18 expression on neutrophils and serum concentration of IL-6 and IL-8 were analyzed by flow cytometry and enzyme-linked immunosorbent assay,respectively.Results: In CPB group plasma levels of IL-6 and IL-8 increased significantly and peaked at 2 h after initiation of CPB(P<0.05),and descended to the after-anesthesia level at 3~(rd) day after operation.In non-CPB group there was a similar trend of changes in IL-6 and IL-8,but to a much lesser extent.The level of CD11b/CD18 in CPB group began to increase significantly and peaked at 15 min after initiation of CPB(P<0.05),and descended to the after-anesthesia level at 2 h after operation.There was no significant changes of CD11b/CD18 in control group(P>0.05).No significant differences were detected at any time points with respect to expression of CD11a/CD18 and CD11c/CD18 in both groups(P>0.05).Conclusions: CPB surgery of children can cause increasing of the CD11b/CD18 expression level of neutrophil but has no significant effect on CD11a/CD18 and CD11c/CD18.CD11b/CD18 may play an important role in the systemic inflammation induced by CPB.