微波定量消融脾组织治疗脾大脾亢对患者免疫功能的影响

Effect of quantitative microwave ablation of spleen to treat splenomegaly and hypersplenism on immune function

目的 探讨脾大、脾亢微波部分消融脾脏组织对机体免疫功能的影响。方法 对脾大、脾亢患者在腹腔镜下或超声引导下经皮行脾组织微波定量消融治疗，治疗前、后分别检测患者外周血T淋巴细胞亚群、B淋巴细胞及NK细胞。结果 治疗后1个月外周血T淋巴细胞亚群CD3、CD4^＋细胞水平明显升高。B细胞水平每个检测时间点均较治疗前明显升高。脾脏微波消融体积≤20%组CD3，CD4^＋细胞水平治疗后1个月较治疗前升高，治疗后3个月时较1个月有所下降；CD8^＋细胞水平治疗后1个月、3个月均高于治疗前；CD4^＋/CD8^＋比值治疗后呈下降趋势；B淋巴细胞水平呈上升趋势；NK细胞治疗后较治疗前降低。脾脏微波消融体积20%~40％组CD3、CD4^＋、CD4^＋/CD8^＋比值、B细胞、NK细胞水平治疗后1个月、3个月均高于治疗前水平，呈上升趋势；CD8^＋细胞水平治疗后1个月、3个月低于治疗前水平，并一直呈下降趋势。其中治疗后3个月，该组CD4^＋ T淋巴细胞水平明显高于消融体积≤20%组。结论 微波定量消融脾脏治疗脾大、脾亢的疗法是一种微创的相当于部分手术切除脾脏的治疗方法，不仅维持了脾脏免疫功能还可提高机体免疫水平； 微波消融脾脏体积大小与治疗后机体免疫功能的恢复和维持有关。

Objective To explore the effect of quantitative microwave ablation on immune function for secondary splenomegaly and hypersplenism. Methods Ten patients with secondary splenomagely and hypersplenism were undergone by microwave ablation of the spleen. Changes of T lymphocyte subsets, B lymphocyte and natural killer cell were detected before and after operation. Results Patients’ level of CD3 and CD4^＋ increased significantly in 1 month after microwave ablation. There were no significant changes of CD8^＋, CD4^＋/CD8^＋ and NK cell level in 1 and 3 months after operation compared with pre-operation level. B lymphocyte increased obviously at each occasion after microwave ablation therapy compared with pre-operation level. According to the spleen ablation volume （AV）, patients whose ablation volume of smaller group, CD3, CD4^＋ increased in 1 month after ablation but decreased slightly, 3 months later, lowering than pre-operation level. CD8^＋ level was higher than pre-operation in 1 and 3 months after operation. CD4^＋/CD8^＋ ratio lower than pre-operation level in 1 month and 3 months after operation. B lymphocyte continued to increase in 3 months after operation. NK cell level was lower than pre-operation. Patients with larger ablation volume, CD3, CD4^＋, ratio CD4^＋/CD8^＋, B lymphocyte and NK cell level increased in 1 month after operation and continued to increase in 3 months after operation. CD8^＋ level lower than pre-operation level in 1 month after operation and continued to decrease 3 months later. Conclusion Microwave ablation therapy for splenomagely and splenectomy preserves part of the anatomic structure of the spleen and maintains its physiological function, especially the immune function, and in the long-term it can partly increase the spleen immune function. From immune point of view, it is safe and effective. There may be a relationship between spleen ablation volume and immune function level of patients after therapy.