体外循环心脏手术患者免疫特征动态变化与预后的研究OA

Objective To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cy-tokines in patients undergoing CPB(cardiopulmonary bypass)cardiac surgery,and to explore their associations with postop-erative outcomes.Methods In this prospective cohort study,120 adult patients who underwent elective cardiac surgery un-der CPB at West China Hospital from May 2022 to March 2023 were enrolled.Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured.The primary outcomes were the sequential organ failure assessment(SOFA)score at 24 h after surgery and ΔSOFA(the peak SOFA score within 48 h after surgery minus the pre-operative SOFA score).Secondary outcomes included major adverse cardiovascular events(MACE),acute kidney injury(AKI),respiratory failure,severe liver injury,and infection.Results The mean age of enrolled patients was 57±10 years.Of these,52%(62/120)were male and 90%(108/120)underwent valve surgery.During the rewarming to the end of CPB,neutrophil counts rapidly increased(7.39×109/L vs preoperative 3.07×109/L,P<0.001),with significant upreg-ulation of CD11b(7.30×109/L vs preoperative 3.05×109/L,P<0.001)and CD54(7.15×109/L vs preoperative 2.99×109/L,P<0.001).Lymphocyte counts increased at the end of CPB(1.75×109/L vs preoperative 1.12×109/L,P<0.001)but decreased significantly at 24 h after surgery(0.59×109/L vs preoperative 1.12×109/L,P<0.001).Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery;five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB.The SOFA score increased from 1(1,2)preoperatively to 7(5,10)at 24 h after surgery,with a ΔSOFA of 6(4,8).Within 30 days after surgery,48 patients(40.0%)developed AKI,17(14.2%)developed infection,4(3.3%)developed severe liver injury,3(2.5%)devel-oped respiratory failure,and 3(2.5%)experienced MACE.During the 2-year follow-up,8 patients(6.7%)experienced MACE and 5(4.2%)died.Conclusion Multi-organ dysfunction is common after cardiac surgery under CPB(median ΔSOFA,6),accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory,anti-inflammatory,and chemotactic mediators.This study provides data-driven evidence and research clues for further inves-tigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical out-comes.