晚期血吸虫病患者脾切除对免疫功能的远期影响

Long-term influence of splenectomy on immunity in advanced schistosomiasis patients

目的探讨脾切除对晚期血吸虫病(晚血)患者体液免疫和细胞免疫的远期影响。方法选择晚血肝纤维化Ⅲ级合并腹水病人55例,分为脾切除组与非脾切除组,抽取周围静脉血检测白细胞(WBC)、红细胞(RBC)、血小板(PLT)、嗜酸性粒细胞(EOS)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、白蛋白(A)、总胆红素(TB)、Ⅲ型前胶原(PC-Ⅲ)、Ⅳ型胶原(Ⅳ-C)、透明质酸(HA)、IgG、IgA、C3、C4、CD3、CD4、CD8、CD56+16。结果非脾切除组TB(27.75±13.11)μmol/L,ALT(27.66±12.82)U/L,ALP(157.16±72.29)U/L,GGT(86.34±92.40)U/L,A(37.76±6.21)g/L,HA(156.32±86.89)mg/L,Ⅳ-C(74.49±23.92)μg/L,PC-Ⅲ(146.53±69.60)mg/L,IgG(20.60±6.12)g/L、IgA(4.45±2.23)g/L、C3(0.66±0.23)g/L、C4(0.14±0.04)g/L,CD3(63.64±11.08)%、CD4(37.59±8.33)%、CD8(21.46±8.74)%、CD56+16(15.58±8.52)%,WBC(2.59±1.08)×109/L,PLT(39.00±16.96)×109/L。脾切除组TB(23.83±14.37)μmol/L,ALT(25.74±11.81)U/L,ALP(179.00±89.06)U/L,GGT(100.59±69.96)U/L,A(3.16±6.01)g/L,HA(25.66±130.72)mg/L,Ⅳ-C(6.86±42.77)μg/L,PC-Ⅲ(53.69±72.35)mg/L,IgG(7.24±11.66)g/L、IgA(6.11±2.14)g/L、C3(0.69±0.18)g/L、C4(0.13±0.05)g/L,CD3(8.07±11.67)%、CD4(6.76±7.56)%、CD8(9.98±11.25)%、CD56+16(8.18±12.24)%,WBC(5.23±1.54)×109/L,PLT(146.41±57.94)×109/L,两组肝功能与肝纤维化水平无明显差异,脾切除组WBC、PLT、IgG、IgA、CD56+16升高,CD3、CD4和A下降。结论晚血患者脾切除后,WBC与PLT升高,细胞免疫下降,体液免疫增强。

A total of 55 cases of advanced schistosomiasis patients combined with Ⅲ-grade hepatic fibrosis and ascites were randomized into a splenectomy group and non-splenectomy group.The peripheral vein blood phlebotomized from these patients were detected for leucocytes,hematids,thrombocytes,acidophils,glutamic-pyruvic transaminase,alkaline phosphatase,albumin,total bilirubin,three-type precollagen,fore-type collagen,hyaluronic acid,IgG,IgA,C3,C4 and the sub-group of lymphocytes such as CD3、CD4、CD8、CD56＋16.There were no significant difference on hepatic function and the level of hepatic fibrosis between the groups above metioned.It could be found that leucocytes,thrombocytes,IgG,IgA,CD56＋16 increased while CD3,CD4,and albumin decreased in the splenectomy group.In conclusion,leucocytes and thrombocytes increase after splenectomy,cytoimmunity declines and humoral immunity enhances.