腹腔镜下直肠癌手术对免疫平衡及CD4^＋CD45RA^＋和CD4^＋CD45RO^＋T细胞的影响

The effect of laparoscopy-assisted rectal cancer surgery on the level of Th1/Th2 balance and change of CD4^ ＋ CD45R cell.

目的通过分别测定腹腔镜手术和开腹手术直肠癌患者Th1／Th2平衡偏移情况及CD4^＋CD45R细胞的比例变化，以比较两种术式对直肠癌患者免疫功能的影响。方法分别采用流式细胞学和酶联免疫吸附法方法检测行腹腔镜下直肠癌手术和常规开腹手术2组患者术前1d、术后2、7d的外周血中CD4^＋IFN-γ^＋T和CD4^＋IL4^＋T细胞比率及IFN-γ和IL-4血清浓度，同时检测CD4^＋CD45RA^＋T细胞和CD4^＋CD45RO^＋T细胞在不同手术影响下的比例变化。结果开腹组术后2、7d的Th1细胞[（4．51±1．52）％，（7．26±2．59）％]与术前[（12．06±1．82）％]相比明显减少（P均〈0．05），Tha2细胞[（6．70±2．41）％，（6．70±2．41）％]与术前[（4．47±1．90）％]相比明显增加（P均〈0．05）；开腹组术后2、7d的IFN-γ[（57．15±23．64）ng／L，（72．70±27．31）ng／L]与术前（123．47±32．52）ng／L相比明显下降（P均〈0．05），而术后2、7d的IL-4[（55．55±7．29）ng／L，（57．56±7．13）ng／L]与术前[（41．87±5．83）ng／L]相比明显升高（P均〈0．05）；腹腔镜组Th1细胞、Th2细胞、IFN-γ和IL-4手术前后数量无明显变化（P均〉0．05）；术后7d开腹组CD4^＋CD45RA^＋T细胞（35．11±7．82）与术前（31．11±6．72）相比明显增加（P均〈0．05），开腹组术后CD4^＋CD45RO^＋T细胞（61．21±9．13）较术前（68．11±11．42）减少（P〈0．05）。结论腹腔镜下直肠癌手术较开腹手术对机体免疫平衡影响较小，有利于保护直肠癌患者的细胞免疫功能。

Objective To explore the difference of the level of Th1/Th2 balance and change of CD4^＋ CD45 R cell after treated by laparoscopy-assisted rectal cancer surgery and conventional open rectal cancer surgery, so to compare the effect of the two procedures on immunity function of the patients. Methods CD4^＋ IFN-γ^＋ T cell （Thl cell）, CD4 ^＋ IL-4 ^＋T cell（ Th2 cell）and the ratio of Th1/Th2 were detected by flow cytometery ; The levels of IFN-γand IL-4 were measured by ELISA. The changes of CD4 ^＋ CD45RA ^＋ T cell and CD4 ^＋ CD45RO ^＋ T cell were detected in the different procedures so that the effect of the two procedures on cytoimmunity and immune balance were analyzed. Results Compared with baseline levels, the level of Thl cells was decreased [ （4.51 ± 1.52 ） %, （7.26±2.59）% vs. （12.06± 1.82 ）% ] （P〈 0.05） ; The level of Th2 cells was increased [ （6.70 ±2.41）%, （6.70 ± 2.41 ） % vs. （4.47 ± 1.90） % ] （ P 〈 0.05 ） ; The level of IFN-γ was decreased [ （ 57.15 ± 23.64 ） ng/L, （72.70 ± 27.31 ）ng/L vs. （123.47 ± 32. 52）ng/L] （P 〈 0. 01 ）; The level of IL-4 was increased [ （55.55 ±7.29）ng/L,（57.56±7.13）ng/L vs. [（41.87 ± 5.83）ng/L] （P 〈0.05） on 2nd and 7th day after conventional open recatal cancer surgery; The level of Thl, Th2, IFN-γ and IL-4 in the laparoscopy-assisted rectal cancer surgery was not different（P 〉 0.05 ）. At 7 day postoperatively, the level of the CD4^ ＋ CD45RA ^＋ T cells was increased （35.11 ± 7.82） and the CD4 ^＋ CD45RO ^＋T cells was decreased（61.21 ± 9.13） compared with surgery before（31.11 ±6.72） and （68.11 ±11.42） respectively （P〈 0.05）. Conclusions The laparoscopy-assisted rectal cancer surgery has less influence on immune balance, thus protect systemic cell immunity.