Cellular immunity impaired among patients on left ventricular assist device for 6 months
Cellular immunity impaired among patients on left ventricular assist device for 6 months
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DOI：
10.1016/j.athoracsur.2008.01.050
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发表时间：
2008-05-01
影响因子：
4.6
通讯作者：
Kasirajan, Vigneshwar
中科院分区：
文献类型：
--
作者：
Kimball, Pam M.;Flattery, Maureen;Kasirajan, Vigneshwar
背景资料。左心辅助装置(LVAD)的持续维护与严重感染的频率增加有关。虽然植入后即刻可见细胞免疫功能的暂时性变化，但持续的LVAD治疗对免疫功能的影响尚不清楚。在体外T细胞活化的功能和表型标记物和6个月临床结果的比较中，患者和心力衰竭对照组患者进行了为期6个月的治疗。与对照组患者相比，接受LVAD治疗的患者的感染率(45.5%比0%；p<；0.05)和死亡率(54%比16%；p<；0.05)更高。接受植物血凝素(3.4+/-4.7vs28.5+/-19.6)、抗CD3(4.3+/-4.5vs16.4+/-17；p<0.01)和葡萄球菌肠毒素B(7.2vs26.3vs26.1+/-15.6；p=0.002)的患者T细胞增殖反应低于对照组。与对照组相比，LVAD受者的增殖性低反应不是由细胞凋亡(2.6%+/-2.7%比2.7%+/-2.1%；p=0.94)或CD4+细胞不足(42.1%+/-11.3%比40.2%+/-7.5%；p=0.71)引起的。相反，左心衰患者的CD3+细胞表达较少的白介素2(2.5%+/-1.5%比5.2%+/-3.1%；p=0.03)和肿瘤坏死因子-α(6.0%+/-3.5%比25.8%+/-8.7%；p<；0.001)和更多的白介素10(5.8%+/-6.1%比2.6%+/-2.1%；p<；0.05)。此外，抑制性T调节细胞在左心室肥厚患者中的比例高于对照组(12.9%+/-3.2%vs1.2%+/-1.1%；p<；0.001)。由于下调细胞因子失衡和抑制性T调节细胞的出现，长期接受LVAD的患者的细胞免疫功能受到损害。
Background. Sustained maintenance on left ventricular assist device (LVAD) is associated with an increased frequency of severe infections. Although temporary changes in cellular immunity are seen immediately after implantation, the consequence of sustained LVAD treatment on immunity is unknown.Methods. In vitro functional and phenotypic markers of T cell activation and 6 month clinical outcome were compared between patients with >= 6-month LVAD therapy and heart failure control patients.Results. Recipients of LVADs had more infections (45.5% versus 0%; p < 0.05) and mortality (54% versus 16%; p < 0.05) than control patients. T-cell proliferative responses were lower among LVAD recipients than control patients when challenged with phytohemagglutinin (3.4 +/- 4.7 versus 28.5 +/- 19.6; p < 0.01), anti-CD3 (4.3 +/- 4.5 versus 16.4 +/- 17; p < 0.01), and staphylococcal enterotoxin B (7.2 +/- 6.3 versus 26.1 +/- 15.6; p=0.002). Proliferative hyporesponsiveness among LVAD recipients was not caused by apoptosis (2.6%+/- 2.7% versus 2.7%+/- 2.1%; p=0.94) or insufficient CD4+ cells (42.1%+/- 11.3% versus 40.2%+/- 7.5%; p=0.71) relative to control patients. Instead, CD3+ cells from LVAD patients expressed less interleukin 2 (2.5%+/- 1.5% versus 5.2%+/- 3.1%; p=0.03) and tumor necrosis factor-alpha (6.0%+/- 3.5% versus 25.8%+/- 8.7%; p < 0.001) and more interleukin 10 (5.8%+/- 6.1% versus 2.6%+/- 2.1%; p < 0.05). In addition, suppressive T-regulatory cells were more prevalent in LVAD patients than control patients (12.9%+/- 3.2% versus 1.2%+/- 1.1%; p < 0.001).Conclusions. Cellular immunity is compromised among long-term LVAD recipients because of a downregulatory cytokine imbalance and emergence of suppressive T-regulatory cells.