门脉高压症患者脾脏免疫学研究

Immunological Study of Huge Spleen in Patients with Portal-hypertension

目的研究门脉高压症巨脾患者切脾前后免疫功能的变化。方法检测正常人和巨脾患者巨脾切脾前后的外周血CD3+,CD4 +,CD8+细胞及tuftsin水平的变化 ;脾外伤者正常脾脏组织和门脉高压症患者巨脾组织的单位面积CD4 +,CD8+,CD2 0 +细胞数 (SABC法 )和Ⅰ ,Ⅲ型胶原 (间接免疫荧光法 )含量。结果①巨脾患者的Ⅰ ,Ⅲ型胶原较正常脾组织显著增生 (P <0 0 1) ,以后者为甚且巨脾组织中CD4 +,CD4 +/CD8+,CD2 0 +细胞均明显降低 (P <0 0 1) ,CD8+细胞增加 (P <0 0 1)。②巨脾患者外周血tuftsin水平 ,CD3+,CD4 +,CD4 +/CD8+明显低于正常对照组 (P <0 0 1) ;切脾后tuftsin水平无改变 ,但切脾后两周外周血CD3+、CD4 +、CD4 +/CD8+有轻度恢复 ,术后 3个月与术后 2周比较无明显变化(P >0 0 5 )。结论门脉高压症巨脾患者免疫功能显著降低。全脾切除能使患者免疫功能得到一定程度的恢复 ,故作者主张切除。

Objective To study the changes of immunological function in patients of portal hypertension(PHT) bearing huge spleens before and after their splenectomy Methods The changes of CD_3^+,CD_4^+,CD_8^+ cells and tuftsin levels in the peripheral blood of healthy subjects and PHT patients with huge spleens during the period of pre- and postsplenectomy were observed;the numbers of CD_4^+,CD_8^+ and CD_20^+ cells per unit area in normal splenic tissue from patients with trauma of spleen and in huge spleen of PHT patients were counted by SABC method, whereas the contents of type Ⅰ and type Ⅲ collagen per unit area in splenic tissues of patients in both groups were estimated by indirect immunofluorescence method. Results①In PHT patient's huge spleens, the numbers of CD_8^+ cells and contents of type Ⅰ and type Ⅲ collagen increased greatly (P<0.01),while the numbers of CD_4^+ and CD_4^+/CD_20^+ cells decreased significantly(P<0.01) as compared with the results of normal splenic tissue.②Comparing with the healthy group,the levels of tuftsin,CD_3^+,CD_4^+ and CD_4^+/ CD_8^+ cells in the peripheral blood of PHT patients declined evidently (P<0.01);the blood levels of tuftsin in PHT patients displayed no any change following the splenectomy, but the numbers of CD_3^+,CD_4^+ and CD_4^+/ CD_8^+ cells in peripheral blood increased slightly two weeks after operation and were maintained on this level until three months later(2 weeks to 3 months, P>0.05). Conclusions The immunological function of PHT patients with huge spleens has decreased obviously in comparison with the healthy subjects, it can be recovered to a certain extent by splenectomy. Therefore, we propose that splenectomy would be suitable for PHT patients bearing huge spleens.