胸腺肽a1对老年患者腹腔镜胰十二指肠切除术后并发症的影响

Effect of thymosin a1 on complications after laparoscopic pancreaticoduodenectomy in elderly patients

目的研究腹腔镜胰十二指肠切除术(LPD)围手术期老年患者的免疫状态与术后感染并发症发生的关系,并探讨胸腺肽a1应用对术后并发症的影响。方法收集2014年6月—2018年6月解放军陆军军医大学第二附属医院收治的43例行LPD的老年患者(66~83岁)的临床资料。随机分成围手术期应用胸腺肽a1组(联合组,n=22)和未使用胸腺肽a1组(对照组,n=21)。观察围手术期患者术前、术后第3天、术后第7天患者的免疫功能指标,包括血清IgG、IgA、IgM、外周血中性粒细胞/淋巴细胞比值(NLP)、CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)变化情况,术后感染并发症(肺部感染、胰漏、腹腔感染)发生情况。此外,检测术前、术后第3天、术后第7天患者血清CRP和炎症因子水平(IL-2、IL-10、TNFα、IFNγ)。计量资料2组间比较采用t检验,同一组内不同时间点间比较采用重复测量资料方差分析,进一步两两比较采用Duncan’s新复极差法;计数资料组间比较采用χ^(2)检验。结果术后第3天、术后第7天联合组血清IgG、IgA、IgM、CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)水平显著高于对照组(P值均<0.05),NLR均显著低于对照组(P值均<0.05)。术后第7天,对照组血清IgG、IgA、IgM、CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)水平较入院时均明显下降(P值均<0.05),NLR明显升高(P<0.05)。联合组术后肺部感染、腹腔感染发生率均明显低于对照组(χ^(2)值分别为1.44、1.65,P值均<0.05)。与对照组术后第3天、第7天相比,联合组患者血清炎症因子IL-2、IL-10、IFNγ表达显著增高(P值均<0.05)。结论手术创伤可导致老年患者免疫功能进一步降低,围手术期应用胸腺肽a1可增强患者免疫功能,并降低术后感染并发症发生率。

Objective To investigate the association between perioperative immune status and postoperative infectious complications in elderly patients undergoing laparoscopic pancreaticoduodenectomy(LPD),as well as the effect of thymosin a1 on postoperative complications.Methods Related clinical data were collected from 43 elderly patients,aged 66-83 years,who underwent LPD in The Second Affiliated Hospital of Army Medical University,PLA from June 2014 to June 2018,and the patients were divided into combination group with 22 patients(with the application of thymosin a1 in the perioperative period)and control group with 21 patients(without the application of thymosin a1).Immune function parameters were observed before surgery and on days 3 and 7 after surgery,including serum levels of IgG,IgA,and IgM,peripheral blood neutrophil-lymphocyte ratio(NLR),changes in CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)ratio,and the incidence rate of postoperative infectious complications(pulmonary infection,pancreatic leakage,and abdominal infection).In addition,the serum levels of C-reactive protein,interleukin-2(IL-2),interleukin-10(IL-10),tumor necrosis factor-α,and interferon-γ(IFN-γ)were measured before surgery and on days 3 and 7 after surgery.The t-test was used for comparison of continuous data between two groups;a repeated measures analysis of variance was used for comparison within each group at different time points,and the Duncan’s new multiple range test was used for further pairwise comparison.The chi-square test was used for comparison of categorical data between groups.Results Compared with the control group on days 3 and 7 after surgery,the combination group had significantly higher serum levels of IgG,IgA,IgM,CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)ratio(all P<0.05)and a significantly lower NLR(P<0.05).From admission to day 7 after surgery,the control group had significant reductions in the serum levels of IgG,IgA,IgM,CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)ratio(all P<0.05)and a significant increase in NLR(P<0.05).The combination group had significantly lower incidence rates of postoperative pulmonary infection and abdominal infection than the control group(χ^(2)=1.44,1.65,all P<0.05).Compared with the control group on days 3 and 7 after surgery,the combination group had significant increases in the serum levels of IL-2,IL-10,and IFN-γ(all P<0.05).Conclusion Surgical trauma can further reduce the immune function of elderly patients,and the use of thymosin a1 during the perioperative period can enhance the immune function of patients and reduce the incidence rate of postoperative infectious complications.