【摘要】 目的　手术应激可引起细胞介导的免疫受到抑制 ,包括淋巴细胞数量减少 ,导致感染并发症增加 ,确切的原因尚不清楚 ,本研究探讨婴幼儿大手术损伤和淋巴细胞凋亡的关系。方法　 1 2例择期大手术婴幼儿和 6例严重感染的婴幼儿 ,择期手术患儿包括先天性胆总管囊肿 7例和先天性巨结肠 5例 ,其中男 8例 ,女 4例 ,年龄 6个月～ 3岁 ;6例正常婴幼儿作为对照 ,抽取外周血 ,用Boyum描述的方法借助梯度离心分离淋巴细胞 ,用AnnexinV/PI双染色法来分析淋巴细胞早期凋亡情况 ,流式细胞仪测定淋巴细胞Fas的表达。结果　术后患儿外周血淋巴细胞明显下降 ,术后 1d为最低 ,术后 3d仍处于低值。大手术组患儿淋巴细胞凋亡率为 (1 4 .1± 1 .1 ) % ,严重感染组为 (1 2 .3±2 .0 ) % ,与正常对照组 (5 .1± 0 .3) %相比有统计学意义 (P <0 .0 5) ;Fas阳性淋巴细胞百分数术毕为(50 .3± 6 .3) % ,术后 1d为 (49.3± 4 .3) % ,与术前 (36 .3± 1 .1 % )相比有统计学意义 (P <0 .0 5)。结论　经历大手术的患儿循环淋巴细胞呈现凋亡的早期征象 ,可能是全身炎症反应中免疫细胞低反应的原因更多还原

【Abstract】 Objective To investigate the relationsh ip between operative stress and apoptosis of peripheral lymphocytes in infancy. Methods Twelve infants (8 boys and 4 girls) with choled ocele ( n =7) and congenital Hirschsprung’s disease ( n =5) who underwent Ro ux-en-Y hepaticojejunostomy and Duhamel procedure respectively. The age ran ged from 6 months to 3 years. Six infants with severe sepsis were included in th is study. Six normal infants were served as control group. The early status of apoptosis was investigated using flow cytometric measurement of annexin-V/PI bi nding to the cell surface of peripheral lymphocytes. Fas expression of lymphocy tes before and after surgery were also studied. Results The percentage of apoptotic lymphocytes was incre ased in severe sepsis group ( 12.3 ± 2.0 %) and infants after major surge ry ( 14.1 ± 1.1 %) than that of the controls ( 5.1 ± 0.3 %, P < 0. 05 ). No significant difference was found between severe sepsis and infants aft er major operation. As compared with the preoperative stage ( 36.3 ± 1.1 %) , Fas positive lymphocytes were increased at the end of surgery ( 50.3 ± 6.3 %) and 24 hours postoperatively ( 49.3 ± 4.3 %, P < 0.05 ). Conclusion An early character of apoptosis of peripheral lymphocytes after operation may contribute to hypo-responsiveness of immune cel l in systemic inflammation in infants.更多还原