梗阻性黄疸病人内毒素血症及其对机体免疫功能的影响

Endotoxemia in patients with obstructive jaundice and its effect on the immunologic function

目的探讨梗阻性黄疸时内毒素血症对机体体液免疫和细胞免疫功能的影响。方法 20例梗阻性黄疸病人为研究对象,20例无黄疸的胆囊结石病人作为对照,观察梗阻性黄疸病人胆肠内引流术前后外周血内毒素(ET)、补体(C_3、C_4)、免疫球蛋白(IgG、IgA、IgM)、T细胞亚群(CD_4^+、CD_8^+)及自然杀伤细胞(NKC)的变化。结果术前良性黄疸组、恶性黄疸组血清ET浓度明显升高。术前良性黄疸组、恶性黄疸组血清C_3、IgA和血浆CD_4^+、CD_8^+、NKC均明显下降。胆肠内引流术后10天,ET水平较术前明显降低,C_3、CD_4^+、CD_8^+、NKC均明显回升。结论梗阻性黄疸时内毒素血症可能是抑制机体体液免疫和细胞免疫功能的重要因素之一,胆肠内引流术可有效地缓解内毒素血症和恢复机体免疫功能。

To detect the effect of endotoxemia on humoral and cellular immunity in obstructive jaundice. Methods Twenty non-jaundiced patients with gallstone as the control group and 20 cases of obstructive jaundice patients as experimental group were involved in this study. The changes of subsets (CD_4^+, CD_8^+) and natural killing cells (NKC) in the peripheral blood of 20 patients with obstructive jaun-dice before and after intenal biliary drainage were investigated. Results The serum ET content was ob-viously increased, and serum C_3, IgA levels and plasma CD_4^+, CD_8^+ and NKC decreased in both benign and malignanat jaundice before operation. Two days after intenal biliary drainage. ET level was de-creased as compared with before operation, while C_3, CD_4^+, CD_8^+ an NKC significantly elevated. Conclu-sion Endotoxemia in obstructive jaundice might be and important factor on depression of host humoral and cellular immunity. Internal biliary drainage could effectively improve host immunity and relieve the endotoxemia.