摘要
目的 研究门脉高压症脾亢患者脾切除前后免疫功能的改变 ,以及巨脾组织免疫活性细胞的数量变化。探讨门脉高压症脾亢患者脾脏切除术合理性的免疫学基础。方法 对门脉高压症脾切除术患者 ,术前检测静脉血T淋巴细胞亚群 (CD3+ 、CD4 + 、CD8+ 、CD2 0 + )及NK细胞 ;白介素 2(IL 2 )和白介素 10 (IL 10 ) ;γ干扰素 (IFN γ) ;免疫球蛋白 (IgG、IgM、IgA)及补体C3、C4。脾切除术后 1周、1月再次检测上述指标。切除的巨脾组织制成石蜡切片 ,检测CD3+ 、CD8+ 、CD2 0 + 、CD6 8+阳性细胞数量及分布 ,与正常脾组织进行比较。结果 ①脾切除术后 1月免疫球蛋白IgG、补体C3、C4均升高 (P <0 .0 5 ) ,IgM、IgA呈增高趋势 ,但无统计学意义。②脾切除术后 1月IL 2、IFN γ明显升高 ,但仍低于正常人 ;IL 10明显降低 ,但仍高于正常人。③脾切除手术前后外周血CD4 + 、CD8+ 、CD4 + /CD8+ 、CD2 0 + 细胞变化均无统计学意义。仅CD3+ 、NK细胞术后 1月明显升高 (P <0 .0 1)。④门静脉高压症巨脾与正常脾脏比较 ,CD3+ 、CD8+ 、CD2 0 + 、CD6 8+ 细胞数均减少。结论 经部分免疫学指标检测 ,门脉高压症脾亢患者免疫功能降低 ,脾切除术能使门脉高压症患者免疫功能得到一定改善。
Objective To investigate the changes of immunological function in patients with portal hypertension (PHT) before and after splenectomy and the changes of the number of immunological cells in splenomegaly. Methods Venous T cell subgroups, NK cells, serum IL 2, IL 10, IFN γ, immunoglobulin, complements C3 and C4 were determined before, 1 week and 1 month after splenectomy. Paraffin sections were prepared for detection of number and distribution of CD3 +, CD8 +, CD20 + and CD68 + cells. The results were compared with those in healthy individuals. Results (1) The values of IgG and complements C3 and C4 were remarkably elevated (P<0.05) and those of IgM and IgA were gradually increased (P>0.05) 1 month after the operation. (2) 1 month postoperatively, levels of IL 2 and IFN γ significantly rose while of IL 10 decreased. However, the former two were lower and the latter higher than those in healthy individuals. (3) After the operation, the levels of CD3 + and NK cells were significantly increased (P<0.01) while those of Cd4 +, CD8 +, CD4 +/CD8 + and CD20 + did not significantly change. (4) The number of CD3 +, CD8 +, CD20 + and CD68 + cells was remarkably lower in patients with PHT accompanied by hypersplenism than that in normal controls. Conclusions The immunological function is damaged in patients with PHT accompanied with hypersplenism. Splenectomy can improve the immunological function.
出处
《消化外科》
CSCD
2004年第4期286-290,共5页
Journal of Digestive Surgery
