CAJ | 학술논문

目的：探讨开腹手术对老年总管结石患者术后T淋巴细胞亚群的影响及降钙素原的变化。方法将老年组与中青年组患者按胆总管结石分类分别行胆管切开取石、T管引流术或胆管空肠吻合术。于术前1d和术后1、3、7d分别测定外周血血常规、降钙素原、T淋巴细胞及其亚群的数量等指标，进行分析。结果老年组降钙素原比中青年组各组均明显增加（P＜0．05），老年组组内第1、3、7天比术前均明显增加（P＜0．05），中青年组组内第1、3天比术前均明显增加（P＜0．05）；老年组比中青年组CD3＋细胞各组间明显减少（P＜0．05），老年组组内第3天比术前明显减少（P＜0．05）；老年组比中青年组CD8＋细胞组间术前及术后第7天明显减少（P＜0．05）；老年组与中青年组CD4＋细胞组间术前、术后第1、7天明显减少（P＜0．05），老年组组内第3天与术前明显减少（P＜0．05）；中青年组组内术后第7天与术前明显减少（P＜0．05）；老年组与中青年组CD4＋／CD8＋细胞各组间均明显减少（P＜0．05），老年组组内第3天与术前明显减少（P＜0．05）。结论老年患者降钙素原比中青年增加，老年患者T淋巴细胞亚群数量减少，开腹手术对老年与中青年胆管结石患者免疫功能影响存在差异。
목적：탐토개복수술대노년총관결석환자술후T림파세포아군적영향급강개소원적변화。방법장노년조여중청년조환자안담총관결석분류분별행담관절개취석、T관인류술혹담관공장문합술。우술전1d화술후1、3、7d분별측정외주혈혈상규、강개소원、T림파세포급기아군적수량등지표，진행분석。결과노년조강개소원비중청년조각조균명현증가（P＜0．05），노년조조내제1、3、7천비술전균명현증가（P＜0．05），중청년조조내제1、3천비술전균명현증가（P＜0．05）；노년조비중청년조CD3＋세포각조간명현감소（P＜0．05），노년조조내제3천비술전명현감소（P＜0．05）；노년조비중청년조CD8＋세포조간술전급술후제7천명현감소（P＜0．05）；노년조여중청년조CD4＋세포조간술전、술후제1、7천명현감소（P＜0．05），노년조조내제3천여술전명현감소（P＜0．05）；중청년조조내술후제7천여술전명현감소（P＜0．05）；노년조여중청년조CD4＋／CD8＋세포각조간균명현감소（P＜0．05），노년조조내제3천여술전명현감소（P＜0．05）。결론노년환자강개소원비중청년증가，노년환자T림파세포아군수량감소，개복수술대노년여중청년담관결석환자면역공능영향존재차이。
Objective To investigate the influence on T lymphocyte subsets and change of procalcitonin after open surgery in elderly patients with choledocholithiasis.Methods Elderly and young patients received cholangiotomy, choledochotomy with T tube drainage or cholangiojejunostomy according to the type of choledocholithiasis.Periphery blood samples from patients were collected on preoperative 1day, and postoperative 1, 3, 7days.The levels of peripheral blood leukocytes, procalcitonin, T lymphocyte subsets were measured and compared in groups divided by age.Results The level of peripheral blood procalcitonin in elderly patients group was significantly higher than in younger patients group(P<0.05).Surgical stress leaded to the increase of procalcitonin in elderly patients group on postoperative 1, 3, 7 days and young group on postoperative 1 and 3 days than preoperative level(P<0.05).Level of CD3 +T cells significantly reduced in elderly group than in young group(P<0.05), the levels of CD3 +T cells were obviously lower in post-operative 3 d than preoperative level (P<0.05).The level of CD8 +T cells on preoperative day and postoperative 7 day in elderly group were significantly lower than in younger group(P<0.05).The level of CD4 +T cells on preoperative day and postoperative 1,7 days in elderly group were significantly lower than in younger group(P<0.05),level of postoperative day 3 in elderly patients were dis-tinctly reduced than preoperative day(P<0.05),level of postoperative day 7 in young patients were distinctly reduced than preopera-tive day(P<0.05).The ratio of CD4 +/CD8 +on preoperative day and postoperative days 1,3,7 in elderly group were significantly lower than in younger group(P<0.05), level of postoperative day 3 in elderly patients were distinctly reduced than preoperative day (P<0.05).Conclusions Procalcitionin in elderly group is higher than in younger group.T lymphocyte subsets are lower.Differ-ences in immune function changes exist between elderly and young choledocholithiasis patients undergoing open surgery.