血清IL-2和SIL-2R在胆道梗阻围手术期中的变化及精氨酸治疗的研究

Clinical study on serum levels of soluble interleukin-2 and interleukin-2 receptor in patients with biliary obstruction and therapeutic effects of arginine

目的探讨胆道梗阻病人围手术期血清白细胞介素-2(IL-2)活性和可溶性白细胞介素-2受体(SIL-2R)水平及精氨酸的免疫调节作用。方法选择1组胆道梗阻病人,按疾病的良恶性分为两组,分别采用放免计数器和双抗体夹心ELISA法测定血清IL-2和SIL-2R水平。另择1组良性胆道梗阻病人术前行为期7d的精氨酸治疗,检测其血清IL-2及SIL-2R水平的变化。结果良恶性两组术前血清IL-2较对照组明显降低,SIL-2R明显高于对照组,术后逐渐恢复,但良恶性两组变化幅度差异明显;血清总胆红素水平与血清IL-2及SIL-2R水平之间密切相关;在良性组,胆道外引流术式较胆道内引流术式相对不利于血清IL-2和SIL-2R水平的恢复;精氨酸可上调良性胆道梗阻病人血清IL-2水平,抑制血清SIL-2R过表达。结论胆道梗阻病人体内存在着血清IL-2活性降低和SIL-2R过度表达,检测血清IL-2和SIL-2R有助于估价病情、判断预后及鉴别胆道梗阻的性质,胆道外引流相对不利于血清IL-2和SIL-2R的恢复,可能与胆汁酸盐丢失导致肠道细菌易位和肠源性内毒素血症有关,精氨酸通过提高血清IL-2活性,抑制血清SIL-2R表达而发挥其免疫调节作用。

[Objective] To evaluate serum interleukin-2（IL-2） and soluble interleukin-2 receptor（SIL-2R） concentration and its clinical significance in patients with biliary obstruction and the immune adjustment of arginine. [Methods] The patients with biliary obstruction were divided into benign group and malignant group, serum IL-2 and SIL-2Rconcentrations of the two groups were dynamically measured in 30 patients with biliary obstruction by radioimmunoassay and ELISA. 25 benign patients with biliary obstruction were treated in seven days by arginine, to observe the changes of preoperative serum IL-2 and SIL-2R concentrations. [Results] Preoperative serum IL-2 concentration of the two groups was significantly lower but the level of SIL-2R was siginificantly higher than those of normal control subjects while postoperative serum levels of IL-2 and SIL-2R resume gradually. But there was a significant differece in the trend between benign and malignant ieteric patients. The rank correlation analysis showed a relationship between the serum level of bilirubin and serum levels of IL-2 and SIL-2R. 12 days after operation, serum IL-2 and SIL-2R concentration of the benign patients treated by external biliary drainge didn＇t come back as compared to those by internal biliary drainage. Arginine can advance significantly serum level of IL-2, restrain serum SIL-2R concentration of the benign patients with biliary obstruction. [Conclusions] There exist low activity of IL-2 and high expression level of SIL-2R in patients with biliary obstruction. Examination of serum IL-2 and SIL-2R comcentration might be a valuable parameter of estimating patientis conditions, assessing patients prognosis and identifying the nature of biliary obstruction. The recovery of IL-2 and SIL-2R concentration by external biliary drainage is relatively slow, which might be related to bacterial translocation and enterogenous endoximia. Arginine might take the immune adjustment effects on the biliary obstructive cases by elevating serum activity of IL-2, in- hibiting high expressive level of SIL-2R.