低体重先天性心脏病婴幼儿围手术期 Th1/Th2 的动态变化

Dynamic changes of Th1/Th2 during perioperative period in infant with low weight and congenital heart disease

摘要:

目的 探究低体重先天性心脏病（以下简称先心病）婴幼儿围手术期辅助性T 细胞1（Th1）/ 辅助性T 细胞2（Th2）的动态变化和对患儿免疫功能的影响。方法 回顾性分析2018 年3 月—2019 年3 月 在河北省儿童医院住院行手术治疗的54 例低体重先心病婴幼儿的临床资料。将患儿分为肺充血组（32 例） 和肺缺血组（22 例）。选取同期该院就诊的32 例低体重其他疾病患儿作为对照组。采用双抗体夹心酶联免疫 法检测所有患儿治疗前、先心病患儿手术结束时及术后1、3 和7 d 的血清γ 干扰素（IFN-γ）、白细胞介 素-4（IL-4）并计算IFN-γ/IL-4。结果 肺充血组IFN-γ、IFN-γ/IL-4 较对照组低（P <0.05），IL-4 较对照组高（P <0.05）；肺充血组IFN-γ/IL-4 低于肺缺血组（P <0.05），肺缺血组IFN-γ/IL-4 低于对照 组（P <0.05）。手术结束时、术后1 和3 d 的IFN-γ、IFN-γ/IL-4 较手术前低（P <0.05），IL-4 较手术前 高（P <0.05）；术后1、3 和7 d 的IFN-γ、IFN-γ/IL-4 较手术结束时高（P <0.05），IL-4 较手术结束时低 （P <0.05）；术后3 和7 d 的IFN-γ、IFN-γ/IL-4 较术后1 d 高（P <0.05），IL-4 较术后1 d 低（P <0.05）； 术后7 d 的IFN-γ、IFN-γ/IL-4 较术后3 d 高（P <0.05），IL-4 较术后3 d 低（P <0.05）。结论 先心病 患儿尤其是肺充血型先心病患儿Th1/Th2 免疫系统功能相对失衡。小年龄、低体重先心病患儿围手术期内 出现IFN-γ/IL-4 的短暂变化，提示出现Th1/Th2 的功能变化，进而导致免疫功能的漂移。

Abstract:

Objective To explore the dynamic changes of T helper cell 1 (Th1)/ T helper cell 2 (Th2) and its influence on immune function in infant low weight and congenital heart disease (CHD). Methods Fifty-four children with CHD who were diagnosed and operated as CHD in our hospital from March 2018 to March 2019 were analyzed retrospectively. They were divided into pulmonary congestion group (n = 32) and pulmonary ischemia group (n = 22), and 32 children with other diseases who were treated in our hospital in the same period were divided into non CHD group. Serum interferon-gamma (IFN-γ) and interleukin-4 (IL-4) were measured by double-antibody sandwich enzyme-linked immunosorbent assay in all children before treatment as well as children with CHD at the end of surgery, 1st day after surgery, 3rd day after surgery, and 7th day after surgery, and calculate the IFN-γ/IL-4 ratio. Results Before treatment, the levels of IFN-γ and IFN-γ/IL-4 in lung congestion group were lower than those in non-CHD group (P < 0.05), and IL-4 was higher than that in non-CHD group (P < 0.05). IFN-γ/IL-4 was lower than that in lung ischemia group (P < 0.05); IFN-γ/IL-4 in lung ischemia group was lower than that in non-CHD group (P < 0.05). Compared with patients before surgery, IFN-γ, IFN-γ/IL-4 decreased at the end of surgery, 1st day and 3rd day after surgery (P < 0.05), and IL-4 increased (P < 0.05); compared with the end of surgery, IFN-γ, IFN-γ/IL-4 were increased on the 1st day, 3rd day and 7th day after operation (P < 0.05), and IL-4 was decreased (P < 0.05); compared with 1st day after operation, IFN-γ, IFN-γ/IL-4 were increased on the 3rd day and 7th day after operation (P < 0.05), and IL-4 was decreased (P < 0.05); compared with 3rd day after operation, IFN-γ, IFN-γ/IL-4 were increased on the 7th days after operation (P < 0.05), and IL-4 was decreased (P < 0.05). Conclusions In children with CHD, especially in children with pulmonary congestion, there is a relative imbalance of Th1/Th2 immune system function. The short-term change of IFN-γ/IL-4 ratio in the perioperative period of infant with low weight and CHD suggests that changes of IFN-γ/IL-4 function, which leads to the shift of immune function.