脾脏切除对新发展晚期血吸虫病患者病情的影响

Impact of splenectomy on newly developed advanced schistosomiasis patients

目的了解脾脏切除对新发展晚期血吸虫病患者病情的影响。方法调查2008?2015年新发展晚期血吸虫病患者93例,确定脾脏切除术者为分层指标,进行相关的医学检查,对当前病情做出评估并分层比较。结果脾切组39例,男11例,女28例,平均年龄(67.3±6.7)岁,脾脏切除平均时间(2.88±2.79)年,其中23例进行手术前后超声指标自身对比。未切组54例,男9例,女45例,平均年龄(72.5±6.3)岁。脾切术后,门静脉内径由(12.7±2.0)mm降至(11.0±1.3)mm(P=0.001);相较于未切组,脾切组的WBC和PLT均值明显较高,异常率明显较低,GGT均值明显较低,HA均值及阳性率均较低,GLO均值大于正常高值且A/G低于1.5者比例较高,LN均值和阳性率明显较高。结论新发展晚期血吸虫病患者存在活跃的肝脏纤维化及脾功能亢进、肝细胞损伤等现象,对机体尤其是肝脏损害较为严重,免疫调节可能发挥重要作用;脾切术能较好地改善脾功能亢进情况,但对疾病发展的影响有待于进一步观察。

Objective To understand impact of splenectomy on newly developed advanced schistosomiasis patients in their disease process.Methods 93 patients newly diagnosed with advanced schistosomiasis from 2008 to 2015 were enrolled and divided into splenectomy group and non-splenectomy group.All patients received clinical examinations and diseases severity evaluations.The results were compared between the two groups.Results 11 males and 28 females were in splenectomy group with mean age of(67.3±6.7)years old.The mean time from surgery to the study was(2.88±2.79)years.23 cases of them had ultrasonic indexes self-contrast before and after surgery.54 patients with mean age of(72.5±6.3)years old were in non-splenectomy group,of which 9 were males and 45 were females.After surgery,diameters of portal vein dropped from(12.7±2.0)mm to(11.0±1.3)mm(P=0.001).WBC and PLT levels in splenectomy group were higher than those in non-splenectomy group,while their abnormality rates were lower.Lower GGT levels,HA levels and HA positive rates were found in splenectomy group,but LN level and its positive rate were higher in this group.Mean values of GLO exceeding high-normal values along with higher proportion of A/G less than 1.5 could also be detected in splenectomy group.Conclusion Newly developed advanced schistosomiasis patients have active hepatic fibrosis,hypersplenism and liver cell damage,which lead to hazards on body especially on the liver.Immune regulation plays a critical role in improving these damages.Splenectomy can be helpful in controlling hypersplenism,but its influence on disease process needs further verifications.