老年人骨科手术创伤后T细胞免疫状况的观察

Immunological functions of T-lymphocyte in elderly patients after orthopedic operation

目的 探讨老年人骨科手术创伤后细胞免疫功能状况及其变化规律。 方法 1998年 5月至 1999年 2月随机选择我院行骨科中大型手术、6 5～ 96岁的老年患者 39例作为实验组 ,选择同期 15例 6个月内无创伤及手术史、6 5～ 80岁的老年患者作对照组。实验组患者分别在手术后第 1、3、7、14天 ,对照组患者在入院后手术前 ,取空腹外周静脉血 1次 ,采用流式细胞仪自动细胞计数法测定T淋巴细胞亚群数量 ,作对比分析。 结果 CD3值对照组为 (6 3 9± 8 3) % ,实验组在术后第 1天为 (5 4 4± 11 3) % ,至第 14天为 (5 8 5± 12 6 ) % ,均显著降低 ,与对照组比较差异有显著性 (P <0 0 5 ) ;CD4值对照组 (40 1± 6 3) % ,实验组在术后第 1天为 (31 8± 8 9) % ,第 3天 (36 1± 8 4 ) % ,较对照组显著降低 (P <0 0 5 ) ;而CD8、CD16、CD4 /CD8值 2组间比较 ,差异均无显著性。实验组整体T淋巴细胞亚群数目 ,均在手术创伤后降低 ,并有从术后第 1天至第 14天由低向高、向正常恢复的趋势。 结论 老年人在手术创伤后会出现细胞免疫功能抑制 ,尤其在手术后 7d内细胞免疫受抑制明显 ,术后第 14天开始逐渐恢复正常。

Objective To evaluate the T lymphocyte functions in elderly patients following major orthopedic operation. Methods From May 1998 to Feb 1999, 39 elderly patients (65 95 years old) hospitalized for orthopedic operation were studied. The patients' peripheral blood samples in the experimental group were obtained on days 1, 3, 7 and 14 postoperation, respectively. At the same days, blood samples were taken from 15 elder patients without trauma and operation (65 80 years old) within 6 months as controls. T lymphocyte subpopulations were differentiated by means of quantitative assay with autocounting method of FCM. Results CD3 T cell count was significantly decreased on day 1(54 4±11 3)% and day 14(58 5±12 6)%, compared with controls (63 9±8 3)% ( P <0 05). CD4 T cell was also decreased on day 1(31 8±8 9)% and day 3(36 1±8 4)%, but it was increased on day 14(47 6±11 9)% compared to controls (40 1±6 3) %( P <0 05). Although CD8, CD16 and the ratio of CD4/CD8T cells were within normal range compared to controls up to 14 days, the mean number of T cell subpopulations were less than controls, showing no significant changes. It was also shown that T lymphocyte number after decreased between days 1 7 was recovered in postoperative 7 14 days. Conclusions Our results provide evidence that T cell mediated immune functions are inhibited in senior patients within orthopedic postoperative 1 7 days, but it was recovered during postoperative 7 to 14 days.