Complete but not partial thymectomy in early infancy reduces T-cell-mediated immune response: Three-year tracing study after pediatric cardiac surgery
Complete but not partial thymectomy in early infancy reduces T-cell-mediated immune response: Three-year tracing study after pediatric cardiac surgery
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DOI：
10.1016/j.jtcvs.2012.12.015
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发表时间：
2013-03-01
影响因子：
6
通讯作者：
Kitagawa, Tetsuya
中科院分区：
文献类型：
--
作者：
Kurobe, Hirotsugu;Tominaga, Takashi;Kitagawa, Tetsuya
目的：胸腺切除术常用于婴幼儿先天性心脏缺损的手术中，以确保手术野。然而，新生儿胸腺切除术如何影响人类免疫系统的后续发展仍不清楚。我们对患者进行了3年的监测，从胸腺切除术开始，在婴儿期早期进行心脏手术。方法：在长达3年的时间里，我们监测了在3个月以下的先天性心脏缺陷手术中接受完全（n = 17）、部分（n = 15）胸腺切除术的儿童的循环淋巴细胞数量和临床病程。免疫球蛋白g的滴度产生应答接种病毒和植物血凝素反应也被测量。结果：手术后6个月，胸腺完全切除而非部分切除患者的T细胞数量，包括CD4（+）和CD8（+）亚群，均有所下降。t细胞数量的减少持续了3年，而B细胞的数量没有变化。在完全切除胸腺的患者中，接种麻疹和风疹病毒后产生的免疫球蛋白g滴度降低，而植物血凝素诱导的T细胞增殖并未受损。此外，在胸腺完全切除而非部分切除的患者中，与传染病相关的住院频率增加。结论：研究结果显示，婴儿期完全胸腺切除术可使循环T细胞数量和T细胞介导的免疫反应减少至少3年，提示在婴儿期早期手术中至少应保留部分胸腺以维持保护性免疫。[J] .中华胸心外科杂志；2013;15:656-62。
Objective: Thymectomy is often performed to secure an operative field in surgery for congenital heart defects in early infancy. However, how neonatal thymectomy affects the subsequent development of the immune system in humans remains unclear. We monitored patients for 3 years from the time of thymectomy that was performed during cardiac surgery in early infancy.Methods: For up to 3 years, we monitored the number of circulating lymphocytes and the clinical course of the children who underwent complete (n = 17), partial, and no (n = 15) thymectomy during congenital heart defect surgery performed at less than 3 months of age. The titers of immunoglobulin-G produced in response to vaccinated viruses and phytohemagglutinin responses were also measured.Results: Six months after surgery, the number of T cells, including CD4(+) and CD8(+) subpopulations, decreased in patients with complete but not partial thymectomy. The reduction in T-cell number persisted for 3 years, whereas the number of B cells did not change. In patients with complete thymectomy, the titers of immunoglobulin-G produced in response to vaccinated measles and rubella viruses were reduced, whereas the phytohemagglutinin-induced proliferation of T cells was not impaired. In addition, hospitalization frequency associated with infectious diseases increased in patients with complete but not partial thymectomy.Conclusions: The results revealed that complete thymectomy in early infancy reduces the number of circulating T cells and T-cell-mediated immune responses for at least 3 years, suggesting that the thymus should be at least partially preserved during surgery in early infancy to maintain protective immunity. (J Thorac Cardiovasc Surg 2013; 145: 656-62)