恶性梗阻性黄疸PTBD对免疫功能影响的前瞻性对照研究

A Prospective Control Study of the Effects of PTBD on Immunity for the Malignant Obstructive Jaundice

目的通过前瞻性临床对照研究,比较经皮肝穿胆道引流术不同引流方法治疗恶性梗阻性黄疸对免疫功能的影响。方法自2006年3月-2007年2月应用PTBD治疗符合入组标准的恶性梗阻性黄疸病例91例,男57例,女34例,年龄30-81岁,平均(60.4±11.6)岁。行PTIEBD(内外引流)的患者随机入组:IED-A组(餐后关闭引流2小时)20例、IED-B组(日间关闭引流)20例、IED-C组(持续关闭引流)15例;行PTEBD(外引流)患者36例。对术前3天内、术后2-4天、术后8-10天、术后1个月外周血总T细胞(TC)、辅助性T细胞(TH)、抑制性T细胞(TS)及TH/TS、免疫球蛋白(IgG,IgA,IgM)进行统计学方差分析。结果术前3天内各组各免疫指标差异无显著性(P>0.05)。术后1个月TC、TH及TH/TS水平IED-B组>IED-A组>ED组,各组间比较均有显著性差异(P<0.05)。术后1个月IgG、IgA水平ED组>IED-A组>IED-B组,IED-B组与ED组间差异具有统计学意义(P<0.05)。术后1个月较术前TC、TH及TH/TS、IgG、IgA水平IED-A组、IED-B组均有明显恢复,差异有统计学意义(P<0.05),ED组差异无统计学意义(P<0.05)。IED-C组TC、TH及TH/TS、IgG、IgA水平术后2-4天与术前比较,差异无明显统计学意义(P>0.05)。结论 IED-A组、B组术后梗黄患者免疫功能可明显恢复,其中IED-B组效果较好;ED组及IED-C组梗黄患者免疫功能无明显恢复。

Objective To evaluate the effect of the different methods of PTBD on immunity to treat the patients with the malignant obstructive jaundice throught this prospective clinical control study. Met.hods There are 91 consecutive cases with the malignant objective jaundice （M：F=57：34）, mean age （60.4±11.6 years） who were selected by our standard were accepted PTBD therapy from 2006.3 to 2007.2. The patients who undergo PTIEBD will be send into three group at random： group IED-A（turn off drainage for 2 hours after each meal） 20 cases, group IED-B（turn off drainage duaring daytime） 20 cases, group IED-C（turn off drainage persistently） 15 cases. Thirty-six patients underwent PTIEBD. TC, TH, TS, TH/TS, IgG, IgA, IgM before operation and 2-4 days, 8-10 days, and 1 month after the operation were analyzed by ANOVA test. Reswlts There is no obvious difference in TC, TH, TS, TH/TS, IgG, IgA, IgM among these groups before operation（P〉0.05）. At 1 month after PTBD, the level of TC, TH, TH/TS： group IED-B〉group IED- A〉group ED, and the difference between three group is obvious（P〈0.05）; the level of IgG, IgA： group ED〉group IED- A〉group IED-B, and comparing group ED with group IED-B, the difference is obvious（P〈0.05）. At 1 month after PTBD, the level of TC, TH, TH/TS, IgG, IgA has been improved in group IED-A and group IED-B obviously（P〈0.05）. TC, TH, TH/TS, IgG, IgA did not change obviously after operation in IED-C group（P〉0.05）. Conclusion The immunity can be improved in group IED-A,B obviously, and group IED-B is better than group IED-A. In group ED and group IED-C, the immunity cann＇t be improved obviously.