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目的:研究乙肝肝硬化肝癌患者围手术期T淋巴细胞亚群和血清免疫球蛋白的变化,为围手术期感染控制及免疫治疗提供依据。方法:以解放军三○二医院肝胆外科一中心2 0 15年01月—2 0 1 5年07月85例乙型肝炎肝硬化患者为研究对象,其中60例为肝细胞肝癌患者,肝癌患者分别于手术前1d及手术后1、3、5、7、10 d采用流式细胞仪检测外周血CD3、CD4、CD8、CD4/CD8的变化,特种蛋白分析仪测定IgA、IgG、IgM的含量。结果:乙肝肝硬化组和乙肝肝硬化合并原发性肝癌组患者与对照组相比,CD3、CD4、CD4/CD8明显降低,CD8明显增高,血清免疫球蛋白IgA、IgG、IgM水平也呈升高趋势;乙肝肝硬化合并原发性肝癌组与乙肝肝硬化组相比,CD3、CD4、CD4/CD8降低更明显,CD8及血清免疫球蛋白IgA、IgG、IgM水平升高更明显;乙肝肝硬化合并肝癌组术后CD3,CD4,CD4/CD8明显低于术前水平,而术后CD8、IgA、IgG、IgM明显高于术前水平。结论:乙肝肝硬化患者存在免疫抑制现象,乙肝肝硬化合并原发性肝癌患者行肝肿瘤切除术,术后免疫功能进一步受到抑制,术后感染风险增加,应采用积极的感染防控策略。
Objective: To study the changes of perioperative T lymphocyte subsets and serum immunoglobulin in patients with hepatocellular carcinoma of liver cirrhosis and provide basis for perioperative infection control and immunotherapy. Methods: A total of 85 patients with hepatitis B cirrhosis from January 2002 to January 2015 were enrolled in this study. Among them, 60 patients were hepatocellular carcinoma and liver cancer respectively The changes of CD3, CD4, CD8 and CD4 / CD8 in peripheral blood were detected by flow cytometry at 1 day before operation and at 1, 3, 5, 7 and 10 days after operation. The contents of IgA, IgG and IgM were measured by special protein analyzer. Results: Compared with the control group, the levels of CD3, CD4 and CD4 / CD8 in patients with hepatitis B cirrhosis and patients with hepatitis B cirrhosis and primary hepatocellular carcinoma were significantly decreased, CD8 significantly increased, and the levels of serum immunoglobulin IgA, IgG and IgM also increased Hepatitis B cirrhosis with primary liver cancer group compared with hepatitis B cirrhosis group, CD3, CD4, CD4 / CD8 decreased more significantly, CD8 and serum immunoglobulin IgA, IgG, IgM levels increased more significantly; hepatitis B The postoperative CD3, CD4, CD4 / CD8 levels in patients with cirrhosis and hepatocellular carcinoma were significantly lower than preoperative levels, but postoperative CD8, IgA, IgG and IgM levels were significantly higher than preoperative levels. Conclusions: Immunosuppression exists in patients with hepatitis B cirrhosis. Hepatic tumor resection was performed in patients with hepatitis B cirrhosis complicated with primary liver cancer. The immune function was further inhibited and the risk of postoperative infection was increased. Therefore, a positive infection prevention and control strategy should be adopted.