脾切除对门静脉高压症患者免疫功能的影响

Immune changes of patients with portal hypertension after splenectomy

目的:通过观察肝功能Child-Pugh A和B级门静脉高压症患者手术前后血清促/抗炎细胞因子和CD4+/CD25+百分比动态变化,探讨门静脉高压症患者手术前后免疫功能变化特点及脾切除对其的影响。方法:将2007年9月至2011年12月收治的36例门静脉高压症患者,依据肝功能分为Child-Pugh A级组和Child-Pugh B级组。在术前、术后7天、术后14天、术后1月、术后3月5个时间点动态观察患者肿瘤坏死因子-α(TNF-α)、白介素(IL)-6、IL-10、IL-4及CD4+/CD25+百分比等相关指标的变化,并观察术前术后患者免疫功能变化特点及脾切除对它们的影响。结果:随着肝功能损害程度的加重,患者的手术时间延长,输血量增加,感染发生机会增多。术前患者肝功能越差,TNF-α和IL-6水平越低(P<0.05)。两组患者TNF-α和IL-6水平存在着一致性,此两项指标在术后7天增长到顶峰,随后逐渐下降;此两项指标在术后3个月时与术后1个月时比较,差异无显著性意义(P>0.05)。术前肝功能越差,IL-10和IL-4水平越低(P<0.05),两组患者IL-10和IL-4水平均在术后14天增长到顶峰,随后逐渐下降,在术后3月Child-Pugh B级组患者的IL-10、IL-4维持在较高水平(P<0.05)。两组患者CD4+/CD25+百分比水平均在术后14天增长到顶峰,随后逐渐下降,术后3月Child-Pugh B级组维持在较高水平(P<0.05)。结论:乙型肝炎肝硬化门静脉高压症患者处于免疫抑制状态,肝功能越差免疫水平越低;脾切除可以改善Child-Pugh B级患者的免疫状态。

Objective： To investigate patients with different Child-Pugh classification for portal hypertension before and after surgery by dynamic levels of pro/anti-inflammatory cytokines and percentages of CD4^＋/CD25 ^＋ in plasma and intervention by splenectomy. Methods： From September 2007 to December 2011, thirty-six with portal hypertension were recruited. The percent- ages of CD4 ＋/CD25 ＋ , tumor necrosis factor-α （ TNF-α）, interleukin-6 （ IL-6）, interleukin-10 （ IL-10）, and interleukin-4 （IL-4） were determined on preoperative, postoperative days 7 and 14, postoperative months 1 and 3. Results： With the severity of the deterioration for liver dysfunction, the operation time was prolonged, the amount of blood transfusion and infection events were also increased, and level of immunity were worse. The pro/anti-inflammatory cytokines levels in the two groups were quite different, the pro-inflammatory cytokines TNF-ct and IL-6 peaked on postoperative days 7 and markedly depleted on postoperative months 1, the anti-inflammatory cytokines IL-10 and IL-4 slowly increased on postoperative days 7 and peaked on postoperative days 14. The percentages of CD4 ^＋/CD25^ ＋ in the two groups peaked on postoperative days 14 and decreased and slowly depleted. The percentages of CD4 ^＋/CD25 ^＋ in Child-Pugh B was group higher levels on postoperative months 3. Conclusion： Patients with portal hypertension caused by hepatitis B cirrhosis are immunosuppression, and are consistent with the severity of the deterioration for liver dysfunction. Splenectomy can improve the immune status for patients with Child-Pugh B liver function.