HIV感染者行胆囊切除手术后主要淋巴细胞亚群的变化

Changes of Lymphocyte Subset in HIV-infected Persons after Open Cholecystectomy

目的检测手术前后患者外周血中淋巴细胞亚群的变化,探讨开腹胆囊切除术(opencholecystectomy,OC)对HIV感染者主要细胞免疫功能的影响.方法对52例患胆囊疾病的HIV阳性患者用同样方法行开腹胆囊切除术(OC).于手术前1 d(POD-1)、术后第3天(POD3)、第7天(POD7)检测血常规、CD3、CD4、CD8及其百分比和CD4/CD8.结果观察手术前后CD4+水平:POD3的CD4+较POD-1和POD7有所降低,但差异无显著性(P>0.05).手术前后CD4/CD8差异也无显著性(P>0.05).患者术后恢复良好,无手术并发症及术后死亡,随访观察(≤3个月)无艾滋病相关症状.结论 OC可能对HIV阳性者主要细胞免疫功能有短暂轻度抑制;总体上HIV阳性者行开腹胆囊切除术是安全的;术前术后应常规检测CD4和CD4/CD8,并将CD4作为评估手术风险和预后的一项重要指标,术前CD4≥200可作为手术安全性的判断依据.

Objective To evaluate the changes of subset of T lymphocyte in peripheral blood and explore the effects of open cholecystectomy on cellular immune responses in HIV-positive persons.Methods 52 HIV positive patients with gallbladder disorders were admitted to the same hospital and received identical open cholecystectomy（OC）.All of them were retrospectively analyzed for preoperative and postoperative subset of T lymphocyte counts（CD3,CD4 and,CD8,and their respective percentages,and CD4/CD8 ratio） with flow cytometric assessment,and for peripheral blood cells on preoperative day 1（POD-1） and postoperative days 3（POD3） and 7（POD7）.Statistical analysis was performed by ANOVA.Results The level of CD4 on postoperative day3（POD3） slighty decreased compared with the preoperative day 1（POD-1） and postoperative days 7（POD-7）,but the difference was not statistically significant（P 〉 0.05）.There was also no clinically significant loss of CD4/ CD8 ratio between preoperation and postoperation（P 〉0.05）.All patients recovered from operation.No postoperative complication or in-hospital deaths occurred.No AIDS related symptoms developed by 3-month follow-up observation.Conclusions Although the open cholecystectomy has shown temporary mild immune suppression in HIV-infected persons in earlier postoperative period,and therefore it is safe for HIV-infected persons in general.Estimating the risk and prognosis of HIV-positive persons receiving open cholecystectomy can regularly depends on the CD4 counts and CD4/ CD8 ratio.CD4 counts ≥200 cell/mL can be as an evidence for safety of open cholecystectomy.