老年人骨科手术后T细胞免疫状况的变化

Changes of immunological functions of T-lymphocyte in the aged patients after orthopedic operation

目的 观察老年人行骨科手术后T细胞免疫功能及其变化动态。方法 以60岁以上行骨科中大型手术的老年患者为研究对象,选择同期6个月内无创伤及手术史、60岁以上的老年患者作为对照组。用流式细胞仪侧定实验组患者分别在手术后第1、5、10、15天,对照组患者在入院后、手术前空腹外周静脉血T淋巴细胞亚群数量,并作比较分析。结果 手术创伤后实验组整体T淋巴细胞亚群数目均降低,且有从术后第1天至第15天逐渐向正常恢复的趋势。CD3值对照组为(64.5±8.9)％,实验组在术后第1、5、10、15天分别为(54.7±13.1)％、(57.8±10.7)％、(58.2±12.6)％和(59.3±11.2)％,均显著降低,与对照组比较,差异有显著性(P<0.05);CD4对照组为(39.6±7.1)％,实验组在术后第1天为(30.9±8.3)％,第5天为(34.8±7.9)％,显著低于对照组(P<0.05),第15天为(43.7±12.8)％高于对照组;比较对照组与实验组的CD8、CD16、CD4/CD8值,差异均无显著性。结论 老年人在手术创伤后会出现细胞免疫功能抑制,手术后5天内细胞免疫受抑制最为明显,术后第15天开始逐渐恢复正常水平。

Objective In order to evaluate the T-lymphocyte functions in the aged patients after major orthopedic operation. Methods The senior patients(>60 years old) hospitalized for major orthopedic operation were studied. The patients' peripheral blood samples in the experimental group were obtained on days 1, 5, 10 and 15 post-operation, respectively. At the same days, the elder patients(>60 years old) without trauma and opration within 6 months were taken blood samples as controls. T-lymphocytic cell subpopulations were examined by FCM. Results The mean number of T-lymphocytic cell subpopulations were less than controls, showing no significant changes. It was shown that T-lymphocyte number after decreased between days 1-10 was recovered in post-operation 10-15 days. CD3 T-cell count was significantly decreased on day 1(54.7 ± 3.1)%、 5(57. 8 ± 10.7)%, 10(58. 2 ± 12. 6) %and 15(59. 3 ± 11. 2)% compared with controls (64.5±8. 9)%(I<0. 05); Compared to controls (39. 6?. 0%, CD4 T cell was decreased on day 1(30. 9±8. 3)% and day 5 (34.8 ± 7.9) %(P<0. 05), it was increased on day 15 (43. 7 ±12. 8)%(P<0. 05). Compared to controls, the levels of CD8、CD16 and the ratio CD4/CD8 T-cellwithin normal range up to 15 days. Conclusions T-cell mediated immunological functions were inhibited in elderly patientswithin orthopedic post-operative 1~5 days and were recovered during post-operative 10-15 days