免疫球蛋白对紫绀型先天性心脏病婴儿术后细胞免疫功能的影响

目的探讨免疫球蛋白对紫绀型先天性心脏病婴儿术后细胞免疫功能的影响。方法回顾性分析2012年3～12月河北省儿童医院心脏外科住院接受先天性心脏病手术治疗40例患者的临床资料,分为两组,免疫球蛋白治疗组：患儿术后1 h在常规治疗的基础上静脉给予免疫球蛋白,用量为1g/（kg·d）,疗程为2 d。对照组术后只进行常规的治疗。两组患儿分别于术前、术后0.5 h、2 d,抽取静脉血5 ml。釆用双抗体夹心酶联免疫吸附测定法（ELISA）分别检测各时间段两组患儿血清干扰素γ（IFN-γ）、白细胞介素4（IL-4）的浓度,并进行比较。结果术前及术后0.5 h两组患儿同时间段血清IL-4、IFN-γ浓度差异无统计学意义（P〉0.05）。术后0.5 h两组患儿血清IL-4、IFN-γ浓度均明显高于术前,差异有统计学意义（P=0.000）。免疫球蛋白治疗组患儿术后2 d血清IL-4浓度与术前相比差异无统计学意义（P=0.362）,而对照组患儿术后2 d血清IL-4浓度较术前明显升高,两组间差异有统计学意义（P=0.006）。术后2 d免疫球蛋白治疗组患儿血清IL-4、IFN-γ浓度明显低于对照组,两组间差异有统计学意义（P=0.039,0.007）。与术后0.5 h相比,对照组患儿术后2 d血清IL-4浓度约下降20.08%（P=0.001）,血清IFN-γ浓度上升17.80%（P=0.001）,差异均有统计学意义;免疫球蛋白治疗组患儿同时间血清IL-4浓度约下降35.38%,两组间差异有统计学意义（P=0.000）,而血清IFN-γ浓度只上升7.60%（P=0.143）,两组间差异无统计学意义。结论术后静脉应用免疫球蛋白,可有效改善因手术、体外循环等因素所导致的细胞免疫功能紊乱,有助于减少术后并发症的发生。

Influence of Immunoglobulin on Cellular Immune Function of Postoperative Infants with Cyanotic Congenital Heart Disease

Objective To investigate the influence of immunoglobulin （Ig） on celluar immune function of postop- erative infants with cyanotic congenital heart disease （CCHD）. Methods Forty infants who underwent surgical repair of CCHD in Department of Cardiac Surgery, Children＇s Hospital of Hebei Province from March to December 2012 were enrolled in this study. All the patients were randomly divided into 2 groups. Patients in Ig group received intravenous Ig treatment at the dosage of lg/（kg· day） for 2 days postoperatively in addition to routine therapy. Patients in the control group only received routine therapy without Ig treatment. Five ml venous blood samples of all the patients were taken preoperatively, 0.5 hour and 2 days postoperatively to examine serum levels of interferon gamma （IFN-γ） and interleukin-4 （IL-4） with double-antibody sandwich enzyme-linked immunosorbent assay （ELISA）, which were compared between the 2 groups. Results There was no statistical difference in serum levels of IL-4 or IFN-γ preoperatively and at 0.5 hour postoperatively between the 2 groups （P 〉 0.05 ）. Serum levels of IL-4 and IFN-γ at 0.5 hour postoperatively were significantly higher than preoperative levels in the 2 groups respectively （P=0.000）. Serum IL-4 level of Ig group 2 days postoperatively was not statistically different from preoperative level （P=-0.362）, while serum IL-4 level of the control group 2 days postopera tively was significantly higher than preoperative level （P=0.006）. Two days after the operation, serum levels of IL-4 and IFN-γ of Ig group were significantly lower than those of the control group respectively （P=0.039 and 0.007 respectively）. Compared with serum levels at 0.5 hour postoperatively in the control group, serum IL-4 level at 2 days postoperatively de- creased by 20.08% （P=-0.001）, and serum IFN-γ increased by 17.80% （P=0.001）. Compared with serum levels at 0.5 hour postoperatively in Ig group, serum IL-4 level at 2 days postoperatively decre