肝硬化患者脾肝体积比与其体液及细胞免疫功能关系初探

The relationship between humoral and cellular immune and spleen-liver ratio

目的:观察肝硬化患者不同脾肝体积比的体液及细胞免疫功能变化,为保脾手术提供保留脾脏体积的相对参考指标。方法:监测不同脾肝体积比患者的体液及细胞免疫学指标,并和健康对照组比较。结果:肝硬化组与健康对照组的IgA、IgG和IgM没有明显的统计学差异,但脾肝体积比>0.8组与健康对照组和脾肝体积比≤0.8组相比较,则有明显的统计学差异,P值分别为0.000和0.003;脾肝体积比≥0.6组和脾肝体积比<0.6组及健康对照组的Treg细胞占CD4+细胞比例比较,有明显的统计学差异,P值分别为0.022和0.018。结论:当脾肝体积比>0.8时,体液免疫功能尤其是初级免疫应答能力明显下降,在脾肝体积比≥0.6时,机体细胞免疫功能出现紊乱,因此考虑是否可以将保留的脾脏体积控制在0.6～0.8以内作为行保脾手术中保留脾脏体积的一个参考。

Objective：To study humoral and cellular immune function change among cirrhosis with different spleen-liver ratio,in order to provide a relative reference index of spleen-volume-preservation in Spleen-preserving surgery.Methods：With CLIA and flow cytometry,humoral immune index（IgA,IgG and IgM） and cellular immune index（the ratio of Treg cells to CD4＋T cell） were observed in hepatocirrhosis patients with the different spleen-liver ratio and control group.Results：There were no statistically significant difference between serum levels of IgA,IgG and IgM in hepatocirrhosis group and healthy group,but IgM was higher in hepatocirrhosis group（spleen-liver ratio 0.8）,and control group.Compared with hepatocirrhosis group（spleen-liver ratio ≤0.8）,and difference had statistical significance.P value was 0.000 and 0.003 respectively.Treg cell to CD4＋ cell number ratio was higher in hepatocirrhosis group（spleen-liver ratio≥0.6）,compared with control group and hepatocirrhosis group（spleen-liver ratio 0.6）.P value was 0.022 and 0.018.Conclusion：When spleen-liver ratio0.8,humoral immune function,especially primary immune response,decreased obversly;when spleen-liver ratio≥0.6,there were cellular immune dysfunction in patient.So we think,according to the immune function,a range from 0.6 to 0.8 of spleen-liver ratio were regarded as a reference index in Spleen-preserving surgery.