Ocena zmian wybranych parametrów immunologicznych i ich wpływ na występowanie infekcji u pacjentów poddanych operacjom serca z użyciem krążenia pozaustrojowego

Abstract

Operations with the use of cardiopulmonary bypass (CBP) evoke immune responses in the patient' organism. The aim of presented study was to quantify changes of selected immune parameters during and after cardiosurgery operation that included CBP use, and determine whether the changes depend on patient age and sex. Moreover, the effort was undertaken to identify such immune parameters that could be helpful in predicting postoperative bacterial infections. Abovementioned goals were achieved by quantitation of CD4, CD8, CD4/CD8, CD3, CD19, CD45, CD16+56+, and CD3+HLA-DR+ lymphocytes, CD14 monocytes, and concentration measurements of IgG, IgM, IgD, IgE, IgG3, and IgA antibodies as well as interleukin 6 in blood samples. 33 patients (including 19 females and 14 males with the age ranging from 18-83 years) altogether, included in the study, were divided into three age-groups (according to cytometry analyses) and two age-groups (according to immune-enzymatic analyses). There was also separate group comprising of three patients with diagnosed postoperative infections. Elevated proportion of cytotoxic and NK lymphocytes during the operation, followed by their decrease in 24th hour after the operation was identified, particularly in the oldest age-group patients. This may indicate suppression of cytotoxic reactions and may became risk factor of postoperative infection. Majority of the immune parameters measured as a response to CBP-supported operation were sex-independent. Increased proportion of B lymphocytes without concomitant increase of antibodies was demonstrated during the first twenty-four postoperative hours. Decreased proportion of cells with CD4 phenotype (T helper cells) and considerable increase of interleukin 6 during the first twenty four hours following the operation may correlate with appearance of bacterial infections. Keywords: cardiopulmonary bypass, antibodies, leukocytes, interleukin 6, flow cytometry, ELISA, bacterial infections