本文關(guān)鍵詞：兒童手術(shù)應(yīng)激后外周血中B7-H3水平變化及臨床意義　出處：《蘇州大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：目的:手術(shù)應(yīng)激可以導(dǎo)致機(jī)體免疫功能受損,使得機(jī)體對(duì)病原微生物的易感性增加,術(shù)后并發(fā)癥和死亡率相應(yīng)升高。B7-H3作為共刺激分子中的一員,在免疫調(diào)節(jié)中發(fā)揮著一定的作用。本課題通過(guò)對(duì)不同程度手術(shù)應(yīng)激患兒外周血中B7-H3水平的檢測(cè),探討其相關(guān)的臨床意義。方法:選擇擇期手術(shù)患兒48例,其中普外手術(shù)組20例,心臟手術(shù)組28例。同時(shí)根據(jù)Anand和Aynsley-Green評(píng)分系統(tǒng)評(píng)定手術(shù)應(yīng)激程度,分為中度應(yīng)激組(n=14)和重度應(yīng)激組(n=34),分別于術(shù)前、術(shù)后即刻、術(shù)后1天、術(shù)后3天和術(shù)后7天采集外周血,檢測(cè)患兒血中B7-H3水平。此外,我們還對(duì)不同時(shí)間點(diǎn)B7-H3水平與患兒的Anand和Aynsley-Green評(píng)分及術(shù)后并發(fā)癥進(jìn)行了相關(guān)性分析。結(jié)果:所有患兒術(shù)后B7-H3水平比術(shù)前明顯降低(p0.01)。普外手術(shù)組患兒,術(shù)后不同時(shí)間點(diǎn)B7-H3水平與術(shù)前相比均有明顯下降(術(shù)后即刻和術(shù)后3天的p0.01,術(shù)后1天和術(shù)后7天的p0.05)。心臟手術(shù)組患兒,術(shù)后即刻與術(shù)后3天的B7-H3水平相比于術(shù)前有明顯的下降(p0.05)。心臟手術(shù)組患兒在術(shù)后1天(p0.05)和術(shù)后3天(p0.01)時(shí)B7-H3的表達(dá)水平相比于普外手術(shù)組有明顯的下降。重度應(yīng)激組患兒在術(shù)后1天、術(shù)后3天和術(shù)后7天時(shí)B7-H3的表達(dá)水平相比于中度應(yīng)激組患兒有明顯的下降(p0.05)。此外,在術(shù)后1天(p=0.010)和3天(p=0.025)的B7-H3水平與患兒的Anand和Aynsley-Green評(píng)分存在負(fù)相關(guān)性。結(jié)論:B7-H3水平在普外手術(shù)和心臟手術(shù)患兒中出現(xiàn)明顯下降,其與手術(shù)應(yīng)激程度緊密相關(guān)。術(shù)后1天和術(shù)后3天B7-H3的水平與患兒的Anand和Aynsley-Green評(píng)分呈負(fù)相關(guān)提示B7-H3可能作為手術(shù)應(yīng)激程度強(qiáng)弱標(biāo)志物而應(yīng)用于臨床。
[Abstract]:Objective: surgical stress can lead to impaired immune function, increase the body's susceptibility to pathogenic microorganism, postoperative complications and mortality increased.B7-H3 as a member of costimulatory molecules, play a role in immune regulation. This study through the detection of different degree of surgical stress in peripheral blood in children with B7-H3 levels and explore its clinical significance. Methods: 48 cases of patients undergoing elective surgery, general surgery group 20 cases, group 28 cases of open heart surgery. At the same time according to the Anand and Aynsley-Green scoring system to evaluate the surgical stress degree, divided into moderate stress group (n=14) and severe stress group (n=34), respectively before operation. Immediately after the operation, 1 days after the operation, after 3 days and 7 days after operation to collect peripheral blood, detect the level of B7-H3 in the blood. In addition, we have Anand and Aynsley-Green score and operation at different time points after B7-H3 level and children 騫跺彂鐥囪繘琛屼簡(jiǎn)鐩稿叧鎬у垎鏋，

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