CAJ | 학술논문

目的：探讨妇科恶性肿瘤腹腔镜术建立CO2气腹过程中的腹膜免疫因子变迁机制。方法选取广州医科大学附属肿瘤医院妇科恶性肿瘤患者64例。根据手术方式将其分为两组，观察组34例，行腹腔镜术；对照组30例，行传统开腹手术。采用流式细胞术测定术前术后外周血CD4+T淋巴细胞、NK细胞及CD4+CD25highCD127lowTreg水平；采用ELISA法检测术后腹膜免疫因子IL-6、TNF-β、TNF-α水平。结果经建立CO2气腹的腹腔镜术后1 d观察组患者外周血CD4+T淋巴细胞、NK细胞水平显著低于对照组，而CD4+CD25highCD127lowTreg细胞水平显著高于对照组(P<0.05)；但术前1 d及术后1周，两组患者的外周血CD4+T淋巴细胞、NK细胞及CD4+CD25highCD127lowTreg细胞水平比较差异无统计学意义(P>0.05)；观察组腹膜免疫因子(IL-6、TNF-α)水平均显著低于对照组，而TNF-β水平显著高于对照组(P<0.05)；CD4+CD25highCD127lowTreg水平与恶性肿瘤的临床分期相关，表现为Ⅱ~Ⅲ期患者显著高于Ⅰ期患者(P<0.05)；经Pearson相关性分析发现：CD4+CD25highCD127lowTreg与IL-6、TNF-α水平呈负相关(r =-0.741、-0.695，P<0.05)；CD4+CD25highCD127lowTreg与TNF-β呈正相关(r =0.694，P<0.05)。结论妇科恶性肿瘤腹腔镜术建立CO2气腹过程中可能通过抑制腹膜免疫因子IL-6、TNF-α水平或增加CD4+CD25high-CD127lowTreg细胞水平的方式降低患者的免疫功能，随术后时间的延长患者免疫功能可恢复。
목적：탐토부과악성종류복강경술건립CO2기복과정중적복막면역인자변천궤제。방법선취엄주의과대학부속종류의원부과악성종류환자64례。근거수술방식장기분위량조，관찰조34례，행복강경술；대조조30례，행전통개복수술。채용류식세포술측정술전술후외주혈CD4+T림파세포、NK세포급CD4+CD25highCD127lowTreg수평；채용ELISA법검측술후복막면역인자IL-6、TNF-β、TNF-α수평。결과경건립CO2기복적복강경술후1 d관찰조환자외주혈CD4+T림파세포、NK세포수평현저저우대조조，이CD4+CD25highCD127lowTreg세포수평현저고우대조조(P<0.05)；단술전1 d급술후1주，량조환자적외주혈CD4+T림파세포、NK세포급CD4+CD25highCD127lowTreg세포수평비교차이무통계학의의(P>0.05)；관찰조복막면역인자(IL-6、TNF-α)수평균현저저우대조조，이TNF-β수평현저고우대조조(P<0.05)；CD4+CD25highCD127lowTreg수평여악성종류적림상분기상관，표현위Ⅱ~Ⅲ기환자현저고우Ⅰ기환자(P<0.05)；경Pearson상관성분석발현：CD4+CD25highCD127lowTreg여IL-6、TNF-α수평정부상관(r =-0.741、-0.695，P<0.05)；CD4+CD25highCD127lowTreg여TNF-β정정상관(r =0.694，P<0.05)。결론부과악성종류복강경술건립CO2기복과정중가능통과억제복막면역인자IL-6、TNF-α수평혹증가CD4+CD25high-CD127lowTreg세포수평적방식강저환자적면역공능，수술후시간적연장환자면역공능가회복。
Objective To discuss the mechanism of peritoneal immune factors change during establishing CO2 pneu-moperitoneum in gynecological malignant tumor laparoscopy. Methods 64 patients with malignant gynecological tumor in Cancer Center of Guangzhou Medical University were selected. According to the operation mode all patients were di-vided into two groups, the observation group (n= 34) was treated with laparoscopic surgery, control group (n = 30) was treated with traditional open operation. The levels of preoperative and postoperative peripheral blood CD4+T lympho-cytes, NK cells and CD4+CD25highCD127lowTreg were detected by flow cytometry. ELISA method was used to detect post-operative peritoneal immune factors IL-6, TNF-β, TNF-α. Results 1 day after establishing CO2 pneumoperitoneum in gynecological malignant tumor laparoscopy, CD4+T lymphocytes, NK cells of observation group were significantly lower than those of the control group, while the level of CD4+CD25highCD127lowTreg cells was significantly higher than that of the control group (P<0.05);but 1 weeks after operation and 1 days before operation, the two groups had no statistically sig-nificant differences in the peripheral blood CD4+T lymphocyte, NK cells and CD4+CD25highCD127lowTreg cells level (P>0.05). In observation group peritoneal immune factors (IL-6, TNF-α) levels were significantly lower than those in the control group, while the level of TNF-βwas significantly higher than that in the control group (P<0.05). Clinical CD4+CD25highCD127lowTreg level was related with clinical staging of malignant tumor, II-Ⅲ clinical staging patients were higher than the Ⅰ clinical staging patients (P < 0.05). Pearson correlation analysis showed that CD4 +CD25high-CD127lowTreg was negatively correlated with IL-6, TNF-α (r=-0.741,-0.695, P<0.05);CD4+CD25highCD127lowTreg and TNF-βwas positively correlated (r=0.694, P<0.05). Conclusion Establishing CO2 pneumoperitoneum in gynecological malignant tumor laparoscopy can decrease patients' immune function by inhibiting IL-6, TNF-α levels and increasing CD4+CD25highCD127lowTreg level, but patients' immune function can be restored with the extension of postoperative time.