肝细胞癌合并肝硬化患者肝脾联合切除术后免疫功能变化的研究

Changes of immune function in liver cirrhosis patients after splenectomy combined with resection of hepatocellular carcinoma

目的 探讨肝细胞癌合并肝硬化患者肝癌切除时联合脾切除术后免疫功能的变化。方法 将 16例肝癌合并肝硬化患者分成 2组 ,即肝癌切除联合脾切除组 ( 7例 )和单纯肝癌切除组 ( 9例 ) ,于术前、术后 2个月取外周血 7ml,采用流式细胞仪检测CD4、CD8、CD4 /CD8,ELISA法检测IL 2、IFN γ、IL 10。 结果 2组患者术前CD4、CD8、CD4 /CD8、IL 2、IFN γ、IL 10水平差异无显著性 ;术后 2个月 ,切脾组CD4 ( 3 8 2 %± 3 7% )、CD4 /CD8( 1 7%± 0 3 % )高于保脾组CD4 ( 3 2 5 %± 4 0 % )、CD4 /CD8( 1 1%± 0 1% ) ,而CD8( 2 3 7%± 3 7% )低于保脾组CD8( 2 9 4 %± 4 0 % ) (P <0 0 5 ) ;切脾组IFN γ[( 10 4 4± 14 9)pg/ml]、IL 2 [( 98 6± 18 6)pg/ml]高于保脾组 [IFN γ( 70 5± 12 6)pg/ml、IL 2 ( 80 9± 13 5 )pg/ml],而IL 10 [( 5 5 5± 11 2 )pg/ml]低于保脾组 [IL 10 ( 89 4± 10 )pg/ml](P <0 0 5 )。 结论肝癌切除时联合脾切除不但没有降低机体T细胞亚群和Th细胞的平衡 ,反而促进其恢复平衡 。

Objective To study the changes of immune function in liver cirrhosis patients after splenectomy combined with resection of hepatocellular circinoma (HCC). Methods Sixteen patients with HCC associated with liver cirrhosis were divided into two groups: splenectomy combined with hepatectomy ( n =7) and hepatectomy ( n =9). T lymphocyte subsets such as CD4, CD8, CD4/CD8 and Th lymphocyte cytokines such as IFN γ, IL 2, IL 10 in 7 ml peripheral venous blood before operation and two months after operation were examined and compared between the two groups. Results There was no significant difference in pre operative CD4, CD4/CD8, IL 2, IFN γ, IL 10 levels in the two groups. Two months after operation, the levels of CD4 (38 2%±3 7%), CD4/CD8 (1 7±0 3), IFN γ [(104 4±14 9)pg/ml], IL 2[(98 6±18 6)pg/ml] were increased and those of CD8 (23 7±13 7)pg/ml and IL 10 [(55 5±11 2)pn/ml] were decreased in the two groups, but the changes in the group of splenectomy combined with hepatectomy were more obvious than those in the hepatectomy group. The levels of CD4 (32 5%±4 0%),CD4/CD8 (1 1±0 1), IFN γ [(70 5±12 6) pg/ml], IL 2 [(80 9±13 5)pg/ml] in the group of splenectomy combined with hepatectomy, were much higher than those in the hepatectomy group; those of CD8 (29 4%±4 0%), IL 10 [(89 4±10 0)pg/ml] level were significantly lower than those in the hepatectomy group ( P <0 05). Conclusion Splenectomy combined with hepatectomy for HCC associated with liver cirrhosis donot decrease but promote the recover T lymphocyte subsets and Th1/Th2 cytokines from imbalance and improve the patient′s antitumor immune function.