肝硬化门静脉高压脾切除后免疫功能状况

Immune state of patients underwent splenectomy for liver cirrhosis and portal hypertension

目的 探讨肝硬化门脉高压病人行脾切除后对机体免疫功能的影响。方法 测定正常人、肝硬化病人、肝硬化门脉高压行脾切除贲门周围血管离断术和行脾切除脾肾静脉分流加断流术后病人的外周血中IgA ,IgG ,IgM ,CD3 ,CD4,CD8,NK细胞。结果 IgA ,IgM在 4组间均无明显差异。IgG与正常组比较 ,肝硬化组、断流手术组、联合手术组均明显升高 (P <0 .0 5 ,P <0 .0 1) ,但在后 3组间无明显差异。CD3,CD4,CD8在四组间均无明显差异。NK细胞在肝硬化组显著低于正常组 (P <0 .0 5 ) ,断流手术组和联合手术组显著高于肝硬化组 (P <0 .0 5 ,P <0 .0 1) ,而与正常组比较无显著差异。结论 肝硬化门脉高压行脾切除术后并不影响体液和细胞免疫功能 ,郁血肿大的脾脏对细胞和体液免疫功能有抑制作用 ,脾切除后获得改善。而肝硬化病人IgG变化有待进一步研究。

Objective To explore the effects of splenectomy on immune functions of the patients with liver cirrhosis and portal hypertension.Methods We determined the concentrations of IgA, IgG and IgM and the quantities of CD3, CD4, CD8 and NK cells in 7 normal subjects (group A), 7 patients without surgical treatment (group B), 12 underwent devascularization in combination with splenectomy (group C) and other 10 underwent conventional splenorenal shunt in combination with devascularization (group D). Results There were no significant differences in the concentrations of IgA and IgM among the 4 groups. The concentration of IgG was markedly increased in groups B, C and D than in group A (P<0.05 & 0.01). There was no remarkable difference among groups B, C and D. As for the number of CD3, CD4 and CD8, no marked difference was found among the 4 groups. The number of NK cells was significantly higher in groups C and D than in group B (P<0.05 & 0.01). There was no remarkable difference among groups A, C and D. Conclusions Splenectomy does not affect the immune function of the patients with liver cirrhosis and portal hypertension while congestive splenomegaly might inhibit it.