Clinical Study On The Immune Function Changes Of Perioperative Patients With Intracranial Aneurysms Clipping Surgery

Objective:Intracranial aneurysms, one kind of high dangerous diseases, take thethird place in the stroke diseases after cerebral thrombosis and hypertensioncerebral hemorrhage. And there were two treatments: clipping surgery andendovascular embolization. During the perioperative period, cerebral vasospasmand brain tissue damage are two main prognostic factors.In order to learn andassess the immune function of perioperative patients, the T cell subsets inperipheral blood were detected and analyzed. And the results could help toprevent and reduce the incidences of cerebral vasospasm、brain injury andpostoperative infection, which could guide the clinical preventions in future．Thepurpose of the present study was to reduce the rate of disability and mortality ofpreoperative patients with intracranial aneurysm clipping surgery and improvethese patients’ life qualities.Methods:30patients（7male patients,23female） with intracranial aneurysmwere treated with clipping surgery during Feb,2011to Mar,2013in our hospital.And their ages range from30to75years old, with average age of54.6±10.26.According to the diagnostic criterion, all these patients are diagnosed asintracranial aneurysm by computed tomographic angiography（CTA）and digital subtraction angiography (DSA).2ml peripheral venous blood was drew on themorning before the day of the clipping surgery, the following morning after thesurgery and during the surgery for each patients. And then, CD3+、CD4+、CD8+T-lymphocyte and CD4+/CD8+ratio in the blood were detectd by flowcytometer.30healthy persons were employed as the normal control groupincluding9male cases and17females with average age of51±12.47years old.There was no statistical significance of age or sex compared with the intracranialaneurysm clipping surgery group(P＞0.05). The CD3+、 CD4+、 CD8+T-lymphocyte and CD4+/CD8+ratio were also measured in the normal controlgroup’s peripheral venous blood.The data were made by the SPSS17.0software.And quantitative data were expressed as mean±SEM. The data between the twogroups were given T test after testing by normal distribution and homogeneity ofvariance. And data before and after the surgery were performed by matching ttest. Enumeration data received the X2test. A p value of0.05or less wasconsidered statistically significant.Results:1Clinical features：Of the30perioperative patients with intracranialaneurysm clipping surger，there were22cases(73.33%) of simple subarachnoidhemorrhage，5cases(16.67％) with intracerebral and subarachnoid hemorrhageand3cases(10.00%) of intracerebral and subarachnoid hemorrhage andhydrocephalus according to brain Computed Tomography (CT). As to theaneurysm position:14cases(46.67%) of internal carotid and postcommunicating artery aneurysm,9cases(30.00%)of anterior communicatingartery aneurysm(ACoAN),5(16.67%) middle cerebral artery aneurysms casesand2cases(0.07%）with multiple intracerebral aneurysms.2. The results of T-lymphocyte subpopulations Patients all had poor T-lymphocyte immune function before, during and aftersurgery. What’s more, the preoperative immune function was poorer than that ofintraoperation or postoperation.CD3+、 CD4+、 CD8+T-lymphocyte andCD4+/CD8+ratio on the morning before the day of clipping were（65.35±8.73）%，（41.43±8.04）%，（31.82±9.38）%and (1.31±0.32)；They were (47.79±7.74）%，（31.57±4.46）%，（34.29±4.39）%and (0.92±0.27) during the operation;they were (39.25±6.22）%，（25.61±5.19）%，（33.58±6.71）%and (0.74±0.35)on the first morning after the sugery.Compared with the normal control group，the results of CD3+、CD4+、CD8+T-lymphocyte and CD4+/CD8+ratio were（68.73±5.85）%，（43.07±5.27）%，（29.85±4.33）%and (1.55±0.46)respectively. There were no significant differences between the intracranialaneurysm group on the morning before the day of the clipping surgery and thenormal control group (P>0.05).The results of CD3+、CD4+、CD8+T-lymphocyteand CD4+/CD8+ratio during the surgery and on the first day after the surgerywere both lower than those on the first morning before the surgery, and thedifferences both were significant（P<0.05）.Conclusions:1.There were no obvious differences between the intracranial aneurysm groupbefore clipping and the normal control group.2. The immune function during and after the clipping surgery were both lowerthan those before the surgery.3.The Immune function of the first day after ntracranial aneurysm surgery arelower than Intraoperative in Perioperative period.