梗阻性黄疸时胆道内压力和门静脉血流与IL-2、sIL-2R及T淋巴细胞亚群变化的关系探讨

A RELATIONSHIP BETWEEN INTRA-BILIARY TRACT PRESSURE, PORTAL VEINOUS FLOW RATE AND INTERLEUKIN-2,SOLUBLE INTERLEUKIN-2 RECEPTOR,T LYMPHOCYTE SUBPOPULATION IN OMTRUCTIVE JAUNDICE

为探讨梗阻性黄疸患者败血症的发生机理，研究了３７例梗阻性黄疸（Ａ组）和９０例胆囊结石（Ｂ组）患者的胆道内压力、门静脉血流速度与白细胞介素－２（ＩＬ－２）、可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）及Ｔ淋巴细胞亚群的关系。Ａ组又分为急诊手术组（Ａ１）、择期手术组（Ａ２）、＞６０岁组（Ａ３）和＜６０岁组（Ａ４）４个亚组。结果显示：Ａ及Ａ１～４各组术前ＣＤ３＋、ＣＤ４＋、ＣＤ８＋值均显著低于术后１０天值（Ｐ＜０．０５或Ｐ＜０．０１），ｓＩＬ－２Ｒ显著高于术后１０天值（Ｐ＜０．０１）。Ａ１组术前ｓＩＬ－２Ｒ极显著高于Ａ及Ａ２～４组（Ｐ＜０．０１）。相关分析显示胆道内压力与ＩＬ－２、ＣＤ３＋、ＣＤ４＋及ＣＤ８＋呈负相关，与ｓＩＬ－２Ｒ呈正相关（Ｐ＜０．０１），门静脉血流速度与ＩＬ－２呈正相关（Ｐ＜０．０１）。由此表明梗阻性黄疸感染与宿主细胞免疫功能降低密切相关。

To investigate the cause of septicemia in patients with obstructive jaundice,the correlationship between intra-binary tract pressure (IBTP),portal veinous now rate (PVFR)and interleukin-2 (IL-2),soluble interleukin-2 receptor(sIL-2R),T lymphocyte subpopulation in patient with obstructive jaundice (Group A)has been studied. Group A was subdivided into A1,emergency operation group;A2,elective surgery group;A3,patient's age over 60 years and A4,age under 60. Ninety patients with simple gallstone (Group B)were also tested as a contrast. The result showed that of all Group A,CD3+,CD4+,CD8+ before operation were much lower than those 10 days after operation(P<0. 05 or P<0. 01),while the postoperative sIL-2R was significantly higher than that of 10 days after operation (P<0. 01 ), in Group A1,emergency surgery, the preoperative sIL-2R was much more higher than that in others of the jaundice group (P<0. 01 ). Corralation analysis showed IBTP was negatively correlated to IL-2,CD3+,CD4+,CD8+,but it had positive correlation with sIL-2R (P<0. 01). PVFR was positively correlated to IL2 (P<0. 01 ). These indicate that obstructive jaundice with infection is closely related to the decreased host immunity.