Biological monitoring of immunological modifications in patients supported with left ventricular assist system

左心室辅助系统支持的患者免疫学改变的生物监测

• 批准号: 13671387
• 负责人: MATSUMIYA Goro
• 金额: $ 2.3万
• 依托单位: Osaka University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2001
• 资助国家: 日本
• 起止时间: 2001 至 2002
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-13671387/
• 关键词: left ventricular assist system; panel reactive antibody; heart transplantation; humoral rejection; hyper cytokinemia; allo-reactive antibody; リンパ球; 左室補助人口心臓; Panel reactive antibody

We investigated a total of 30 patients with end-stage heart failure awaiting heart transplantation. Age ranged between 7 and 54, mean of 32.9. Twenty seven patients were male and 3 were female. Among them, 15 underwent the implantation of left ventricular assist system. Anti-T and B cell antibodies against pooled panel cells from Japanese population were measured in these patients. Serum IL-6 and IL-8 level were also examined. As the antibodies against HLA class-I are known to have close relations with post-transplant rejections, the changes of the anti-T antibodies and clinical courses were analyzed. Anti-T cell antibody level became positive in 4 of 15 patients (26.7%) with LVAS and 2 of 15 patients (13.3%) without LVAS. One of 2 patients without LVAS and with positive T cell Abs received heart transplantation successfully and underwent no significant rejection episodes. The other patients continued to have positive T cell Ab level for more than a year, therefore received immunosuppressive therapy with cyclophosphamide. His Ab level dropped significantly and awaiting heart transplantation. Two LUAS patients with positive T cell Abs experienced spontaneous decrease of Ab level. One patient, who also had spontaneous decrease of Ab level underwent heart transplantation. Although direct cross-match was negative, he experienced severe humoral rejection a week after the transplant. Plasma exchange and intense immunosuppressive therapy successfully control this rejection episode. Significant elevation, of the level of anti-donor spleen cell antibodies were detected. The other LVAS patient had a complicated course with persistent infectious complications and expired from infectious endocarditis. His anti-T cell Ab level, serum IL-6 and IL-8 level were persistently high, suggesting hyper-cytokinemia may play a role in enhancing a production of all-antibodies

我们总共调查了 30 名等待心脏移植的终末期心力衰竭患者。年龄介于 7 岁至 54 岁之间，平均年龄为 32.9 岁。 27 名患者为男性，3 名女性。其中15例接受了左心室辅助系统植入。在这些患者中测量了针对来自日本人群的混合组细胞的抗 T 细胞和 B 细胞抗体。还检查了血清IL-6和IL-8水平。由于已知HLA I类抗体与移植后排斥反应密切相关，因此对抗T抗体的变化和临床过程进行了分析。 15 名患有 LVAS 的患者中有 4 名 (26.7%) 的抗 T 细胞抗体水平呈阳性，而 15 名没有 LVAS 的患者中有 2 名 (13.3%) 的抗 T 细胞抗体水平呈阳性。 2 名无 LVAS 且 T 细胞抗体阳性的患者中的 1 名成功接受了心脏移植，并且没有出现明显的排斥反应。其他患者T细胞抗体水平持续阳性一年多，因此接受环磷酰胺免疫抑制治疗。他的抗体水平显着下降，正在等待心脏移植。两名 T 细胞抗体阳性的 LUAS 患者出现抗体水平自发下降。一名抗体水平自发下降的患者接受了心脏移植。尽管直接交叉配血呈阴性，但移植后一周他经历了严重的体液排斥。血浆置换和强力免疫抑制治疗成功控制了这种排斥反应。检测到抗供体脾细胞抗体水平显着升高。另一名 LVAS 患者病程复杂，伴有持续感染性并发症，并因感染性心内膜炎去世。他的抗 T 细胞抗体水平、血清 IL-6 和 IL-8 水平持续较高，表明高细胞因子血症可能在增强全抗体的产生中发挥作用

项目成果

O Monta, G Matsumiya, M Nishimura, H Matsuda: "Management of patient with LUAS support for bridging to, heart transplantation"ICU & CCU. 25(7). 493-498 (2001)

O Monta、G Matsumiya、M Nishimura、H Matsuda：“使用 LUAS 支持桥接心脏移植的患者管理”ICU

T Masai, Y Sawa, S Ohtake, T Nshida, M Nishimura, N Fukushima, T Yamaguchi, H Matsuda: "Hepatic dysfunction after left ventricular mechanical assist in patients with end-stage heart failure : role of inflammatory response and hepatic microcirculation"Ann

T Masai、Y Sawa、S Ohtake、T Nshida、M Nishimura、N Fukushima、T Yamaguchi、H Matsuda：“终末期心力衰竭患者左心室机械辅助后的肝功能障碍：炎症反应和肝脏微循环的作用”Ann

Nishimura M, Ohtake S, Sawa Y, Fukushima N, Matsumiya G, et al.: "Severe aortic valve fusion after nearly three years of support with the Novacor left ventricular assist system"J Thorac Cardiovasc Surg. 124. 179-180 (2002)

Nishimura M、Ohtake S、Sawa Y、Fukushima N、Matsumiya G 等人：“经过近三年的 Novacor 左心室辅助系统支持后出现严重主动脉瓣融合”J Thorac Cardiovasc Surg。

G Matsumiya, S Ohtal e, M Nishimura, Y Sawa, N Fukushima, S Taketaru, K Horiguchi, S Miyagawa, H Matsuda H: "Assessment of sympathetic nerve activity in patients with long term mechanical support"Journal of Congestive Heart Failure and Circulatory Support

G Matsumiya，S Ohtal e，M Nishimura，Y Sawa，N Fukushima，S Taketaru，K Horiguchi，S Miyakawa，H Matsuda H：“长期机械支持患者交感神经活动的评估”充血性心力衰竭和循环杂志

Masai T, Sawa Y, Ohtake S, Nishida T, Nishimura M, Fukushima N, et al.: "Hepatic dysfunction after left ventricular mechanical assist in patients with end-stage heart failure role of inflammatory response and hepatic microcirculation"Ann Thorac Surg. 73.

Masai T，Sawa Y，Ohtake S，Nishida T，Nishimura M，Fukushima N，等：“左心室机械辅助后肝功能障碍对终末期心力衰竭患者炎症反应和肝脏微循环的作用”Ann Thorac Surg。