CAJ | 학술논문

目的：观察门静脉高压症患者行脾切除术前后外周血中Th 17等免疫细胞的变化，分析脾切除于对门静脉高压症患者免疫功能的影响。方法选取中国人民解放军第一八医院2012年6月至2014年6月收治的采取脾切除术治疗的门静脉高压症患者25例作为观察组，同期25例健康体检者作为对照组。采用流式细胞术检测患者术前1 d、术后7 d、1个月、3个月，以及健康体检者外周血中T淋巴细胞亚群CD3、CD4、CD8、CD4/CD8及Th17细胞比率，ELISA检测患者血清中白细胞介素（IL）6、IL-17、IL-23的变化情况。组间数据比较采用单因素方差分析（one-way ANOVA）和 LSD-t检验进行。结果门静脉高压症患者脾切除术前CD3、CD4、CD8、CD4/CD8值明显低于正常对照组（P均＜0．01），Th17细胞及其相关炎症因子IL-6、IL-17、IL-23水平显著高于正常对照组（P均＜0．01）。门静脉高压症患者脾切除术后7 d、术后1个月、3个月的CD3、CD4、CD8、CD4/CD8值均先降低后升高，术后7 d的CD3、CD4、CD8、CD4/CD8值低于术前水平（P均＜0．01），但术后3个月CD3、CD4、CD8、CD4/CD8值与正常对照组相比差异无统计学意义（P均＞0．05）。门静脉高压症患者脾切除术后7 d、术后1个月、3个月的Th17细胞及其相关炎症因子IL-6、IL-17、IL-23水平均逐渐降低（P均＜0．05）。结论脾切除术可以下调门静脉高压症患者Th17细胞及其相关炎症因子IL-6、IL-17、IL-23，使患者免疫功能得到改善。
목적：관찰문정맥고압증환자행비절제술전후외주혈중Th 17등면역세포적변화，분석비절제우대문정맥고압증환자면역공능적영향。방법선취중국인민해방군제일팔의원2012년6월지2014년6월수치적채취비절제술치료적문정맥고압증환자25례작위관찰조，동기25례건강체검자작위대조조。채용류식세포술검측환자술전1 d、술후7 d、1개월、3개월，이급건강체검자외주혈중T림파세포아군CD3、CD4、CD8、CD4/CD8급Th17세포비솔，ELISA검측환자혈청중백세포개소（IL）6、IL-17、IL-23적변화정황。조간수거비교채용단인소방차분석（one-way ANOVA）화 LSD-t검험진행。결과문정맥고압증환자비절제술전CD3、CD4、CD8、CD4/CD8치명현저우정상대조조（P균＜0．01），Th17세포급기상관염증인자IL-6、IL-17、IL-23수평현저고우정상대조조（P균＜0．01）。문정맥고압증환자비절제술후7 d、술후1개월、3개월적CD3、CD4、CD8、CD4/CD8치균선강저후승고，술후7 d적CD3、CD4、CD8、CD4/CD8치저우술전수평（P균＜0．01），단술후3개월CD3、CD4、CD8、CD4/CD8치여정상대조조상비차이무통계학의의（P균＞0．05）。문정맥고압증환자비절제술후7 d、술후1개월、3개월적Th17세포급기상관염증인자IL-6、IL-17、IL-23수평균축점강저（P균＜0．05）。결론비절제술가이하조문정맥고압증환자Th17세포급기상관염증인자IL-6、IL-17、IL-23，사환자면역공능득도개선。
Objective To investigate the effects of splenectomy on peripheral immune cells including Th17 cells in patients with portal hy-pertension and to analyze the influence of splenectomy on their immune function.Methods Twenty-five portal hypertension patients trea-ted with splenectomy in No.180 Hospital of PLA from June 2012 to June 2014 were selected as observation group,and 25 healthy controls who underwent physical examination in the same period as control group.Flow cytometry was used to determine the percentages of CD3 , CD4,and CD8 T lymphocytes,CD4/CD8 ratio,and percentage of Th17 cells in the peripheral blood of portal hypertension patients (1 day before operation and at 7 days,1 month,and 3 months after operation)and healthy controls.ELISA was used to evaluate the changes in ser-um interleukin-6 (IL-6),interleukin-17 (IL-17),and interleukin-23 (IL-23).Comparison between groups was made by one-way ANOVA and LSD-t test.Results Before splenectomy,the portal hypertension patients had significantly lower percentages of CD3, CD4,and CD8 T lymphocytes and CD4/CD8 ratio (P<0.01 for all)and significantly higher percentage of Th17 cells and levels of their as-sociated inflammatory cytokines (IL-6,IL-17,and IL-23)(P<0.01 for all),as compared with the control group.At 7 days,1 month,and 3 months after operation,the percentages of CD3,CD4,and CD8 T cells and CD4/CD8 ratio in portal hypertension patients first decreased and then increased,and these values were significantly lower at 7 days after operation than before operation (P<0.01 for all);at 3 months after operation,the patients showed no significant differences in the percentages of CD3,CD4,and CD8 T cells and CD4/CD8 ra-tio compared with the control group (P>0.05 for all).At 7 days,1 month,and 3 months after operation,the percentage of Th17 cells and levels of their associated inflammatory cytokines (IL-6,IL-17,and IL-23)in portal hypertension patients decreased gradually (P<0.05 for all).Conclusion Th17 cells and their associated inflammatory cytokines (IL-6,IL-17,and IL-23)are reduced in portal hy-pertension patients treated with splenectomy,so their immune function can be improved.