心肺バイパス手術を受けた幼児における単球性ヒト白血球抗原DRの発現

Monocytic human leukocyte antigen DR expression in young infants undergoing cardiopulmonary bypass.

• Alexis Chenouard
• Marie Rimbert
• Nicolas Joram
• Cécile Braudeau
• Antoine Roquilly
• Pierre Bourgoin
• Karim Asehnoune

抄録

背景:

単球性ヒト白血球抗原DR（mHLA-DR）発現レベルは、免疫抑制のマーカーであり、敗血症および死亡率の予測因子であることが報告されている。しかし，心肺バイパス術後の乳幼児におけるmHLA-DRのモニタリングに関するデータはほとんどない．我々の目的は、mHLA-DR発現の動態を調べ、mHLA-DRレベルが心肺バイパス後の乳幼児の医療関連感染（HAI）と関連しているかどうかを判断することであった。

BACKGROUND: Monocytic human leukocyte antigen DR (mHLA-DR) expression levels have been reported to be a marker of immunosuppression and a predictor of sepsis and mortality. There is, however, scant data regarding mHLA-DR monitoring in young infants after cardiopulmonary bypass. Our objectives were to investigate the kinetics of mHLA-DR expression and to determine whether mHLA-DR levels are associated with healthcare-associated infection (HAI) after cardiopulmonary bypass in young infants.

方法:

心肺バイパス術前後の先天性心疾患を有する乳児 49 例（生後 3 ヵ月未満）を対象に，標準化された方法でフローサイトメトリーを用いて mHLA-DR レベルを解析した．結果は、細胞あたりの抗HLA-DR抗体の数（AB/c）として表される。

METHODS: mHLA-DR levels were analyzed by flow cytometry using a standardized method in 49 infants (< 3 months old) with congenital heart disease before and after cardiopulmonary bypass. Results are expressed as the number of anti-HLA-DR antibodies per cell (AB/c).

結果:

術後の mHLA-DR 発現は，すべての乳児で減少した．術後4日目のmHLA-DR発現は、HAI群ではHAIなし群に比べて有意に低かった（3,768 AB/c [1,938-6,144] vs. 13,230 AB/c [6,152-19,130]; p = 0.0142）。mHLA-DR発現は術後の重症度と関連しているが、術後の重症度が高い患者（体外膜酸素療法および/またはコルチコイドおよび/または胸骨閉鎖遅延）では、最初の72時間でのmHLA-DR≦4,500 AB/cは、一変量解析でHAIの発生と関連している（OR = 6.3、95％CI 1.0; 38.7; p = 0.037）。

RESULTS: Postoperative mHLA-DR expression was reduced in all of the infants. Eleven patients (22%) developed HAI and 4 patients (8%) died during the 30-day follow-up. mHLA-DR expression was significantly lower on postoperative day 4 in the HAI group compared to those who without HAI (3,768 AB/c [1,938-6,144] vs. 13,230 AB/c [6,152-19,130]; p = 0.0142). Although mHLA-DR expression is associated with postoperative severity, mHLA-DR ≤ 4,500 AB/c in first 72 hours among patients with higher postoperative severity (extracorporeal membrane oxygenation and/or corticoids and/or delayed closure of sternum) is associated with occurrence of HAI in univariate analysis (OR = 6.3, 95% CI 1.0; 38.7; p = 0.037).

結論:

心肺バイパス術は乳幼児のmHLA-DR発現を著しく低下させる。術後重症度の高い患者では、術後早期のmHLA-DRの低レベルはHAIの発症と関連している。

CONCLUSIONS: Cardiopulmonary bypass induces a profound decrease in mHLA-DR expression in young infants. Among patients with higher postoperative severity, low level of mHLA-DR in the early postoperative period is associated with the development of HAI.

Copyright © 2020. Published by Elsevier Inc.