CAJ | 학술논문

目的：探讨脾切除对丙型病毒性肝炎（丙肝）后肝硬化门静脉高压症患者细胞免疫功能的影响。方法本前瞻性研究对象为2011年12月至2013年12月在西安交通大学第二附属医院行脾切除+贲门周围血管离断术的12例丙肝后肝硬化门静脉高压症患者。其中男4例，女8例；平均年龄（55±8）岁。另选择12名健康体检者作为对照组。所有入选者均签署知情同意书，符合医学伦理学规定。观察患者术前及术后2、6周外周血NK、自然杀伤T细胞（NKT）、CD4+、CD8+T细胞百分率及CD4+/CD8+比值的变化。手术前后不同淋巴细胞亚群的比较采用Wilcoxon秩和检验。结果患者术后6周CD3-CD56+CD16+ NK细胞百分率7.7%，明显高于术前的6.2%（T=1.992，P<0.05）；术后2、6周CD56dim NK细胞百分率分别为94.9%、96.4%，明显高于术前的87.9%（T=2.747，2.201；P<0.05）；术后2、6周CD56bright NK细胞百分率分别为3.8%、2.4%，明显低于术前的9.2%（T=2.747，2.201；P<0.05）。术后2、6周CD3+CD56+ NKT细胞百分率分别为7.3%、7.0%，明显高于术前的6.5%（T=2.275，1.572；P<0.05）。术后2周CD4+ T细胞百分率为41.7%，明显低于术前的45.7%（T=3.059，P<0.05），术后6周进一步降低至26.7%（T=2.201，P<0.05）；而CD8+ T细胞百分率术后2周从术前的21.1%明显升高至24.8%（T=2.432，P<0.05），术后6周进一步升高至35.3%（T=1.992， P<0.05）。术前CD4+/CD8+比值为2.0，在术后2、6周明显下降至1.4、0.8（T=2.981，1.992；P<0.05）。结论丙肝后肝硬化门静脉高压症患者脾切除术后细胞免疫功能明显改善。
목적：탐토비절제대병형병독성간염（병간）후간경화문정맥고압증환자세포면역공능적영향。방법본전첨성연구대상위2011년12월지2013년12월재서안교통대학제이부속의원행비절제+분문주위혈관리단술적12례병간후간경화문정맥고압증환자。기중남4례，녀8례；평균년령（55±8）세。령선택12명건강체검자작위대조조。소유입선자균첨서지정동의서，부합의학윤리학규정。관찰환자술전급술후2、6주외주혈NK、자연살상T세포（NKT）、CD4+、CD8+T세포백분솔급CD4+/CD8+비치적변화。수술전후불동림파세포아군적비교채용Wilcoxon질화검험。결과환자술후6주CD3-CD56+CD16+ NK세포백분솔7.7%，명현고우술전적6.2%（T=1.992，P<0.05）；술후2、6주CD56dim NK세포백분솔분별위94.9%、96.4%，명현고우술전적87.9%（T=2.747，2.201；P<0.05）；술후2、6주CD56bright NK세포백분솔분별위3.8%、2.4%，명현저우술전적9.2%（T=2.747，2.201；P<0.05）。술후2、6주CD3+CD56+ NKT세포백분솔분별위7.3%、7.0%，명현고우술전적6.5%（T=2.275，1.572；P<0.05）。술후2주CD4+ T세포백분솔위41.7%，명현저우술전적45.7%（T=3.059，P<0.05），술후6주진일보강저지26.7%（T=2.201，P<0.05）；이CD8+ T세포백분솔술후2주종술전적21.1%명현승고지24.8%（T=2.432，P<0.05），술후6주진일보승고지35.3%（T=1.992， P<0.05）。술전CD4+/CD8+비치위2.0，재술후2、6주명현하강지1.4、0.8（T=2.981，1.992；P<0.05）。결론병간후간경화문정맥고압증환자비절제술후세포면역공능명현개선。
ObjectiveTo investigate the effect of splenectomy on cellular immune function of patients with hepatitis C virus (HCV) related cirrhotic portal hypertension.MethodsTwelve patients with HCV-related cirrhotic portal hypertension undergoing splenectomy + pericardial devascularization in the Second Affiliated Hospital of Xi'an Jiaotong University between December 2011 and December 2013 were enrolled in this prospective study. Among the 12 patients, 4 were males and 8 were females withthe average age of (55±8) years old. Moreover, 12 healthy people were enrolled in the control group. The informed consents of all patients were obtained and the local ethical committee approval had been received. Percentage of natural killer (NK) cell, natural killer T (NKT) cell, CD4+ cell, CD8+T cell and CD4+/CD8+ ratio in peripheral blood before and 2, 6 weeks after splenectomy were observed. The comparison on different lymphocyte subsets was conducted using Wilcoxon rank-sum test.ResultsThe percentage of CD3-CD56+CD16+ NK cell 6 weeks after splenectomy was 7.7%, which was signiifcantly higher than 6.2% before splenectomy (T=1.992,P<0.05). And the percentage of CD56dim NK cell 2 and 6 weeks after splenectomy was respectively 94.9% and 96.4%, which was signiifcantly higher than 87.9%before splenectomy (T=2.747, 2.201;P<0.05). The percentage of CD56bright NK cell 2 and 6 weeks after splenectomy was respectively 3.8% and 2.4%, which was signiifcantly lower than 9.2% before splenectomy (T=2.747, 2.201;P<0.05). The percentage of CD3+CD56+ NKT cell 2 and 6 weeks after splenectomy was respectively 7.3% and 7.0%, which was significantly higher than 6.5% before splenectomy (T=2.275, 1.572;P<0.05). Percentage of CD4+ T cell 2 weeks after splenectomy was 41.7%, which was signiifcantly lower than 45.7% before splenectomy (T=3.059,P<0.05), and further decreased to 26.7% 6 weeks after splenectomy (T=2.201,P<0.05), while percentage of CD8+ T cell increased from 21.1% before splenectomy to 24.8% 2 weeks after splenectomy (T=2.432,P<0.05), and further increased to 35.3% 6 weeks after splenectomy (T=1.992,P<0.05). The CD4+/CD8+ ratio before splenectomy was 2.0 and decreased to 1.4 and 0.8 respectively 2 and 6 weeks after splenectomy (T=2.981, 1.992;P<0.05).ConclusionThe cellular immune function of patients with HCV related cirrhotic portal hypertension after splenectomy improves signiifcantly.