脾切除对丙型病毒性肝炎后肝硬化门静脉高压症患者细胞免疫功能的影响

Effect of splenectomy on cellular immune function of patients with hepatitis C virus related cirrhotic portal hypertension

目的探讨脾切除对丙型病毒性肝炎(丙肝)后肝硬化门静脉高压症患者细胞免疫功能的影响。方法本前瞻性研究对象为2011年12月至2013年12月在西安交通大学第二附属医院行脾切除+贲门周围血管离断术的12例丙肝后肝硬化门静脉高压症患者。其中男4例,女8例;平均年龄(55±8)岁。另选择12名健康体检者作为对照组。所有入选者均签署知情同意书,符合医学伦理学规定。观察患者术前及术后2、6周外周血NK、自然杀伤T细胞(NKT)、CD4+、CD8+T细胞百分率及CD4+/CD8+比值的变化。手术前后不同淋巴细胞亚群的比较采用Wilcoxon秩和检验。结果患者术后6周CD3-CD56+CD16+NK细胞百分率7.7%,明显高于术前的6.2%(T=1.992,P<0.05);术后2、6周CD56dim NK细胞百分率分别为94.9%、96.4%,明显高于术前的87.9%(T=2.747,2.201;P<0.05);术后2、6周CD56bright NK细胞百分率分别为3.8%、2.4%,明显低于术前的9.2%(T=2.747,2.201;P<0.05)。术后2、6周CD3+CD56+NKT细胞百分率分别为7.3%、7.0%,明显高于术前的6.5%(T=2.275,1.572;P<0.05)。术后2周CD4+T细胞百分率为41.7%,明显低于术前的45.7%(T=3.059,P<0.05),术后6周进一步降低至26.7%(T=2.201,P<0.05);而CD8+T细胞百分率术后2周从术前的21.1%明显升高至24.8%(T=2.432,P<0.05),术后6周进一步升高至35.3%(T=1.992,P<0.05)。术前CD4+/CD8+比值为2.0,在术后2、6周明显下降至1.4、0.8(T=2.981,1.992;P<0.05)。结论丙肝后肝硬化门静脉高压症患者脾切除术后细胞免疫功能明显改善。

Objective To investigate the effect of splenectomy on cellular immune function of patients with hepatitis C virus （HCV） related cirrhotic portal hypertension. Methods TweNe patients with HCV-related cirrhotic portal hypertension undergoing splenectomy ＋ pericardial devascularization in the Second Affiliated Hospital of Xi＇an Jiaotong University between December 2011 and December 2013 were enrolled in this prospective study. Among the 12 patients, 4 were males and 8 were females with the average age of （55-4-8） years old. Moreover, 12 healthy people were enrolled in the control group. The informed consents of all patients were obtained and the local ethical committee approval had been received. Percentage of natural killer （NK） cell, natural killer T （NKT） cell, CD4＋ cell, CD8＋T cell and CD4＋/CD8＋ ratio in peripheral blood before and 2, 6 weeks after splenectomy were observed. The comparison on different lymphocyte subsets was conducted using Wilcoxon rank-sum test. Results The percentage of CD3-CD56＋CD16＋ NK cell 6 weeks after splenectomy was 7.7%, which was significantly higher than 6.2% before splenectomy （T=1.992, P〈0.05）. And the percentage of CD56dlm NK cell 2 and 6 weeks after splenectomy was respectively 94.9% and 96.4%, which was significantly higher than 87.9% before splenectomy （T=2.747, 2.201; P〈0.05）. The percentage of CD56bdght NK cell 2 and 6 weeks after splenectomy was respectively 3.8% and 2.4%, which was significantly lower than 9.2% before splenectomy （T=2.747, 2.201; P〈0.05）. The percentage of CD3＋CD56＋ NKT cell 2 and 6 weeks after splenectomy was respectively 7.3% and 7.0%, which was significantly higher than 6.5% before splenectomy （T=2.275, 1.572; P〈0.05）. Percentage of CD4＋ T cell 2 weeks after splenectomy was 41.7%, which was significantly lower than 45.7% before splenectomy （T=3.059, P〈0.05）, and further decreased to 26.7% 6 weeks after splenectomy （T=2.201, P〈0.05）, while percentage of CD8＋ T cell increased from 21.1% before splenectomy to 24.8% 2 weeks after splenectomy （T=2.432, P〈0.05）, and further increased to 35.3% 6 weeks after splenectomy （T=1.992, P〈0.05）. The CD4＋/CD8＋ ratio before splenectomy was 2.0 and decreased to 1.4 and 0.8 respectively 2 and 6 weeks after splenectomy （T=2.981, 1.992; P〈0.05）. Conclusion The cellular immune function of patients with HCV related cirrhotic portal hypertension after splenectomy improves significantly.