风湿性心脏病心脏瓣膜置换术后细胞免疫与心肌酶谱水平、心功能的关系分析

为探讨风湿性心脏病(简称风心病)患者心脏瓣膜置换术后细胞免疫与心肌酶谱水平、心功能的关系,对52例接受心脏瓣膜置换术的风心病患者的临床资料进行回顾性分析。结果显示,风心病患者淋巴细胞百分比、CD4^+/CD8^+均于术后1 d下降(P<0.05),且术后7、14 d均逐渐恢复(P<0.05);心肌酶谱[肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(creatine kinase isoenzyme-MB,CK-MB)、乳酸脱氢酶(lactate dehydrogenase,LDH)、α羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase,α-HBD)、天门冬氨酸氨基转移酶(aspartate transaminase,AST)]均于术后1 d升高(P<0.05),且术后7、14 d均逐渐下降(P<0.05);心功能指标[射血分数(ejection fraction,EF)、缩短分数(fractional shortening,FS)]均于术后1 d下降(P<0.05),EF于术后7、14 d逐渐升高(P<0.05),FS术后14 d高于术后1 d(P<0.05);风心病心脏瓣膜置换术后不同时刻淋巴细胞百分比、CD4^+/CD8^+与CK、CK-MB、LDH、α-HBD、AST水平呈负相关(P<0.05),术后不同时刻CD4^+/CD8^+与EF、FS水平呈正相关(P<0.05)。提示应积极改善风心病患者心脏瓣膜置换术围术期的细胞免疫功能,这可能有利于改善患者的心肌酶谱水平,减轻心功能损伤。

Relationship between cellular immunity and myocardial enzymogram and cardiac function in patients with rheumatic heart disease after heart valve replacement

To investigate the relationship between cellular immunity and myocardial enzymogram and cardiac function of patients with rheumatic heart disease after heart valve replacement,52 patients with rheumatic heart disease who underwent heart valve replacement were selected in this study.The results showed that lymphocyte percentage and CD4^+/CD8^+were decreased on day 1 post-operation(P<0.05),and gradually recovered on day 7 and 14(P<0.05).Myocardial enzymogram[creatine kinase(CK),creatine kinase isoenzyme-MB(CK-MB),lactate dehydrogenase(LDH),α-hydroxybutyrate dehydrogenase(α-HBD),aspartate transaminase(AST)]was increased on day 1 post-operation(P<0.05),and decreased gradually 7 and 14 days later(P<0.05).Cardiac function[ejection fraction(EF),fractional shortening(FS)]decreased on day 1 post-operation(P<0.05),and EF increased gradually on day 7 and 14(P<0.05).FS on day 14 was higher than that on day 1(P<0.05).Pearson correlation analysis showed that lymphocyte percentage,CD4^+/CD8^+were negatively correlated with CK,CK-MB,LDH,α-HBD and AST levels at different time after operation(P<0.05),while CD4^+/CD8^+was positively correlated with EF and FS levels at different time after operation(P<0.05).These results suggest that the cellular immune function of patients with rheumatic heart disease in perioperative period of heart valve replacement should be improved in order to improve the myocardial enzymogram and alleviate the damage of cardiac function.