Effect Of Immunoglobulin On Cellular Immune Function In Postoperative Infants With Cyanotic Congenital Heart Disease

Objective: Children with CHD are prone to pulmonary infections, thetraditional view is that it is mainly related with the hemodynamic factors. Butthere is also the view that children with CHD exist immune function defects ofdifferent levels.,and immune functions are associated with the types of CHD.Immune function of these children in recent years has come under attention,studies indicate that these children are not only in low immune function, butalso in immune function disorder. The body’s immune system mainly consistsof humoral immunity and cellular immunity. Studies have shown that thenumber of helper T cell (CD4) in the body of children with CHD is lowerthan in the body of normal children of the same age, the number ofsuppression of T cell (CD8) increases, ratio of CD4/CD8decreases,whichfurther prove that the cellular immunity of children with CHD is low. IFN-rand IL-4are inflammatory cytokines produced by helper T lymphocytes,mainly involved in the cellular immune response. In normal condition, TH-1and Th-2cells are in a relatively balanced state, IFN-r and IL-4are also in arelatively balanced state. Some data indicate that to intravenous injectimmunoglobulin can promote to change Th1to Th2,.The cell immunity can beregulated by controlling imbalance between Th1and Th2.The immune function of children with cyanotic congenital heart diseasesappear more abnormal.,and good immune state is a key factor to improve thesuccess rate of surgery. In cardiac surgeries, contact of blood andextracorporeal circulation pipeline, operation trauma, ischemia-reperfusioninjury, chang of body temperature, endotoxin release can cause systemicinflammatory responses, including activation of complement, platelet,andleukocyte, generation of mediators of inflammation,such as endothelin, thromboxane, oxygen free radicals, interleukin, and tumor necrosis factors.The release of the inflammatory factors is closely related to postoperativemultiple organs failure. Therefore, enhance the immune function in childrenwith CHD, and reduce the production of inflammatory factors, which areimportant measures to improve the success rate of operation and theprognosis.The study is to intravenous inject immunoglobulin on some infants withcyanotic CHD after surgeries,and then we detect concentration of IFN-r, IL-4in different periods by enzyme linked immunosorbent assay technology.At lastbetween the group with immunoglobulin and one not we compare theconcentration of IFN-r, IL-4at the same time in order to discuss the effect ofimmunoglobulin on cellular immune function in babies with CHD afteroperations, and find ways to improve the postoperative survival rate, reducethe postoperative complications and provide clinical data.Method: We choose40patients who had cardiac surgery in children’sHospital of Hebei province between2012March and2012December asfollows:1All cases were patients with right-to-left shunt congenital heart disease,theyare within1year, the weight is not more than10kg.2All children have no other serious diseases history, no other hypoxia-relateddiseases history, no serious infections and autoimmune diseases.3The experiment was approved by the Hebei Provincial Children’s HospitalEthics Committee, the parents signed informed consentThe selected patients were randomly divided into group A and group B,Patients in group A gave intravenous immunoglobulin based on routinetreatment after1hour of operation, the dosage is1g/kg.d,2days for acourse.Children in group B only received conventional treatment. Two groupsof patients had venous blood of5ml in the preoperative perod, postoperative0.5h,and postoperative2D. Bloods samples were centrifugated, andcryopreservated. Using the method of double antibody sandwich ELISA, theconcentration of IL-4and IFN-r samples of A, B were detected in each period, Analysis of all data were analised by SPSS13.0statistical software,multiple comparisons between groups were used single factor analysis ofvariance, P<0.05had statistical significance.Results:1The effect of the operation and extracorporeal circulation on theconcentratio n of IL-4and IFN-r.There is no significant difference between two groups in operation beforeand after operation of0.5h in the concentration of IL-4and IFN-r betweeneach other. The concentration of IFN-r and IL-4in the two groups after0.5hwere significantly higher than those before surgeries.,and the differences werestatistically significant. Two groups of children from preoperative topostoperative2D,concentration of IL-4increased firstly and then decreasedgradually with time, concentration of IFN-r showed a trend of increasinggradually.2Effect of immunoglobulin on concentrations of IL-4and IFN-rThe concentration of IL-4in group after2D of operation compared withthe one preoperative, which signed no significant difference. but after2D theconcentration of IL-4in group B after2D of operation was significantlyhigher than the one preoperative, the difference was statistically significant.2D after operations, concentrations of IL-4and IFN-r ware lower than in thegroup B, there was significant difference between two groups.Compared withconcentrations0.5h after operation, concentration of IL-4of2D afteroperation in group B decreased by about20.08%, the concentration of IFN-rincreased by17.80%, the differences of which were statistically significant.At the same time,concentration of IL-4in geoup A decreased by about35.38%,the difference was statistically significant. Concentrations of IFN-r increasedonly7.60%, which made no difference.Conclusions:In this study, by detecting changes on concentrations of IL-4and IFN-r indifferent periods in children with CHD, it was further confirmed the effect ofoperations and extracorporeal circulation on the cellular immune function in patients.Some children gave immunoglobulin after operations,which caneffectively reduce the levels of IL-4and IFN-r, the levels of which have beenincreased and could be continue to be elevated by factors of operation,extracorporeal circulation., postoperative administration of immunoglobulinhas regulated the disorder cellular immune function on children after operationto a certain extent.