CAJ | 학술논문

目的探索射频消融治疗肝硬化门静脉高压性脾功能亢进症的近远期疗效以及其对机体细胞免疫功能的影响.方法使用随机分组的方法将符合纳入标准的43例患者分为射频治疗组(22例)和手术对照组(21例).两组患者分别于术前和术后1周、1个月、6个月、1年、2年、3年时采静脉血进行血常规、淋巴细胞转化率、NK细胞活性和淋巴细胞亚群的测定,使用t检验对组间差异进行对比分析. 结果两组患者脾亢症状均得到较好的缓解.射频治疗组各项细胞免疫指标手术前后无明显差别;手术对照组术后NK细胞活性和T淋巴细胞转化率均明显低于术前水平(P值均小于0.05),与射频治疗组差异亦非常显著.虽然随着术后时间的延长,其NK细胞活性和T淋巴细胞转化率呈现一定的上升趋势,但是仍与术前水平有显著下降.手术对照组CD4+T细胞及CD4+/CD8+比值较术前有显著降低(P值均小于0.05),但是随着术后时间延长其表现出逐渐恢复的趋势,其中CD4+T细胞和CD4+/CD8+比值分别在术后30个月(P=0.078)和术后36个月(P=0.103)时恢复至术前水平.结论 RFA治疗脾亢在较好的缓解患者脾亢症状的同时由于保留了部分脾脏组织从而较好的保留了机体的细胞免疫功能,且具有创伤小,易操作,并发症少的优点,值得在临床上推广应用.
목적 탐색사빈소융치료간경화문정맥고압성비공능항진증적근원기료효이급기대궤체세포면역공능적영향.방법 사용수궤분조적방법 장부합납입표준적43례환자분위사빈치료조(22례)화수술대조조(21례).량조환자분별우술전화술후1주、1개월、6개월、1년、2년、3년시채정맥혈진행혈상규、림파세포전화솔、NK세포활성화림파세포아군적측정,사용t검험대조간차이진행대비분석. 결과 량조환자비항증상균득도교호적완해.사빈치료조각항세포면역지표수술전후무명현차별;수술대조조술후NK세포활성화T림파세포전화솔균명현저우술전수평(P치균소우0.05),여사빈치료조차이역비상현저.수연수착술후시간적연장,기NK세포활성화T림파세포전화솔정현일정적상승추세,단시잉여술전수평유현저하강.수술대조조CD4+T세포급CD4+/CD8+비치교술전유현저강저(P치균소우0.05),단시수착술후시간연장기표현출축점회복적추세,기중CD4+T세포화CD4+/CD8+비치분별재술후30개월(P=0.078)화술후36개월(P=0.103)시회복지술전수평.결론 RFA치료비항재교호적완해환자비항증상적동시유우보류료부분비장조직종이교호적보류료궤체적세포면역공능,차구유창상소,역조작,병발증소적우점,치득재림상상추엄응용.
Objective To explore the short and long term result and the impact on cell immunity of splenic radiofrequence ablation in patients with hypersplenism.Methods In this study 43 patients were divided into the RFA treatment group(22 cases)and open splenectomy control group(21 cases).Blood samples were collected for blood routine,lymphocyte transformation efficiency,NK cell activity and T lymphocyte subpopulations at 1 week,1 month,6 month,1 year,2 years and 3 years before and after operation respectively and the results were compared between the two groups.Results The hypersplenism of the patients in both groups were relieved.There were no significant difierences in cell indices between the postoperative and preoperative values in the two groups.In the control group,compared with the preoperative values in the trial group,the postoperative NK cell activity and lymphocyte transformation efficiency were significantly reduced(P＜0.05).Even though,with time,the NK cell activity and lymphocyte transformation efficiency were on an increasing tendency after operation but still significantly lower than that before operation.In the control group,compared with the preoperative values,CD4+T cell count and CD4+/CD8+ratio decreased significantly(P＜0.05).Moreover.with time.these indices were on an increasing tendency.CIM+T cell count and CD4+/CD8+ ratio restored to the preoperative values within 30 months(P=0.078)and 36 months(P=0.103)respectively.Conclusion RFA treatment for hypersplenism preserves a part of the spleen and thus preserves patient's cell immunity.This treatment exhibits microinvasiveness and few complications and being easy to operate.Hence,RFA treatment for hypersplenism merits wide clinical application.