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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。
Objective To investigate the effect of immunoglobulin on cellular immune function in infants with cyanotic congenital heart disease. Methods The clinical data of 40 patients undergoing cardiac surgery in Hebei Children’s Hospital from March 2012 to December 2012 were retrospectively analyzed. The patients were divided into two groups: immunoglobulin treatment group: Treatment based on intravenous immunoglobulin, the dose of 1g / (kg · d), treatment for 2 d. The control group was treated only routinely. Two groups of children were preoperative and postoperative 0.5 h, 2 d, venous blood drawn 5 ml. The levels of IFN-γ and IL-4 in the two groups were detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). The levels of interleukin-4 (IL-4) Results There was no significant difference in serum IL-4 and IFN-γ levels between the two groups before and 0.5 h after operation (P> 0.05). The serum levels of IL-4 and IFN-γ in the two groups after operation 0.5 h were significantly higher than those before operation (P = 0.000). There was no significant difference in serum IL-4 level between the two groups (P = 0.362), but the level of IL-4 in the control group was significantly higher than that before operation There was a significant difference between the two groups (P = 0.006). The serum levels of IL-4 and IFN-γ in the immunoglobulin group were significantly lower than those in the control group on day 2 postoperatively (P = 0.039,0.007). Compared with 0.5 h after operation, the serum IL-4 concentration in control group decreased by 20.08% (P = 0.001) and the serum IFN-γ concentration increased by 17.80% (P = 0.001) two days after operation, the difference was statistically significant (P = 0.000), while serum IFN-γ concentration increased by only 7.60% (P = 0.143) .Conclusion: The level of IL-4 in the immunoglobulin group is about 35.38% There was no significant difference between the two groups. Conclusions The application of immunoglobulin after intravenous injection can effectively improve the cellular immune dysfunction caused by surgery, cardiopulmonary bypass and other factors, and help to reduce the incidence of postoperative complications.