| Objective Rheumatic heart disease(RHD)is the leading cause of cardiovascular disease morbidity and mortality in children and young adults in low-and middle-income countries,leading to about 250,000 deaths worldwide each year.The disease is caused by an abnormal autoimmune response to A group of streptococcus type A infections.It has become one of the major diseases threatening people's life and health.Questions remain about the best strategies for prevention and early diagnosis of RHD.With the development of medical technology,heart surgery is a key intervention to prevent the early death of RHD patients.RHD heart surgery involves valvular repair or replacement using bioremediation or mechanical valves.After cardiac surgery,RHD patients require penicillin prophylaxis to prevent recurrence of rheumatic fever,and most patients also require anticoagulation to prevent thromboembolic events with mechanical prosthesis and/or atrial fibrillation.However,most of the patients had sustained myocardial damage,poor recovery of cardiac function or continuous aggravation.Previous studies have found that,due to extracorporeal circulation,blood transfusion and other surgical operations,the level of cellular immunity may decline after heart valve replacement,affecting the recovery of postoperative myocardial function.However,there are few studies on the relationship between postoperative cellular immunity level and the damaged state of myocardial cells and cardiac function.In view of this,this study examined the changes of cellular immunity level,myocardial enzyme spectrum and cardiac function index at each moment after heart valve replacement of rheumatic heart disease,and preliminarily explored the relationship between cellular immunity level and myocardial enzyme spectrum and cardiac function index..Methods The clinical data of 52 patients with rheumatic heart disease admitted to the hospital from February 2018 to February 2019 who underwent heart valve replacement were retrospectively analyzed.The changes of cellular immunity index,myocardial enzyme level and cardiac function index were observed at different times 1 d before and1 d after surgery,7 d and 14 d,and the correlation between cellular immunity and myocardial enzyme level and cardiac function was analyzed.The statistical tool SPSS20.0 analyzed and processed the data,and the measurement data were expressed as mean ± standard deviation(' x±s).One-way anova was used for the comparison of various samples,and snk-q test was used for the comparison of further pairs of samples.Pearson correlation coefficient method was used to calculate the correlation coefficient r of the two samples.P < 0.05 was statistically significant.Results Lymphocytes and CD4+/CD8+ were compared at different moments,and the differences were statistically significant(P < 0.05).Compared with the preoperative level,the CD4+/CD8+ was decreased on the 1st and 7th day after the operation and on the 1st day after the operation(P < 0.05),while the CD4+/CD8+ was not changed on the14 th day after the operation(P > 0.05).Compared with 1 day after surgery,lymphocytes and CD4+/CD8+ were increased on 7 and 14 days after surgery(P < 0.05).Compared with 7 days after the operation,lymphocytes increased on the 14 th day after the operation(P < 0.05),and CD4+/CD8+ did not change on the 14 th day after the operation(P > 0.05).Comparison of myocardial enzyme levels at different moments showed statistically significant differences(P < 0.05).Compared with the preoperative results,all the indexes of myocardial enzyme were increased on the 1st and 7th day after the operation(P < 0.05),and no significant changes were observed on the 14 th day after the operation(P > 0.05).With the extension of postoperative time,all indexes of myocardial enzyme spectrum showed a decreasing trend(P < 0.05).The EF and FS levels of cardiac function indexes at different times were compared,and the differences were statistically significant(P < 0.05).Compared with the preoperative level,the EF and FS levels decreased at different time after operation(P < 0.05).The EF level increased with time(P < 0.05).FS level increased 14 days after operation compared with1 and 7 days after operation(P < 0.05).There was no change in FS level on postoperative day 1 and 7(P >,0.05).Lymphocytes and CD4+/CD8+ were negatively correlated with the levels of CK,ck-mb,LDH,HBD,and AST at different moments after heart valve replacement(P < 0.05),while lymphocytes were not correlated with EF and FS at different moments(P > 0.05).CD4+/CD8+ was positively correlated with EF and FS at different moments after surgery(P < 0.05)..Conclusion Rheumatic heart valve replacement after the cellular immune level is restrained,and improves gradually with the extension of time,the cellular immune level and negatively related to the level of myocardial enzyme spectrum and CD4 + / CD8 +and cardiac function were positively correlated,further prompt clinical work after can be adjusted by rheumatic heart valve replacement in the cellular immune level,especially the level of CD4 + / CD8 + affect the level of myocardial damage and promote heart function recovery. |
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