肝移植术后早期合并脓毒症患者的免疫功能障碍  

Effects of early developed sepsis on postoperative immune status in patients undergoing liver transplantation

作　　者：李敏如[1] 汪根树[1] 张琪[1] 易慧敏[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《中华普通外科杂志》2012年第6期467-470,共4页Chinese Journal of General Surgery

基　　金：基金项目：国家973计划基金资助项目（2009CB522404）;国家十一五科技重大专项基金资助项目（2008ZX10002-026）;广州市科技计划基金资助项目（200921-211）;国家自然科学基金资助项目（30972914）

摘　　要：目的研究肝移植患者发生术后早期脓毒症时机体免疫状态的变化特点。方法前瞻性选取2008年10月至2009年7月因慢性重型肝炎行肝移植手术患者19例，比较其与健康人群（20例）免疫状态的差异，并根据术后早期是否发生脓毒症分成脓毒症组（HSS组）和非脓毒症组（HSNS组），观察2组患者手术前后不同时期外周血T淋巴细胞亚群的动态变化。结果与健康人群相比慢性重型肝炎患者T％、IFN-γ/IL4均显著下降，CIM＋CD25＋Foxp3＋Treg（％）、Foxp3 mRNA以及IL-10浓度明显上升。9例患者术后早期发生脓毒症，2组患者T％在术后第1天均较术前显著下降，HSNS组第14天恢复至术前水平，而HSS组仍维持在较低水平。HSNS组在术后第14天Treg％（t=3．265，P=0．004）和Foxp3mRNA表达（t=2．750，P=0．013）与术前相比明显降低，而HSS组术后则略呈上升趋势。HSNS组术后IFN-γ/IL4有所上升，术后第3天最为显著（t=2．261，P=0．036），HSS组术后各时间点与术前比较无明显变化。两组患者IL-10浓度术后均明显下降，其中HSNS组一直维持在较低水平，而HSS组术后第14天再次上升至术前水平。结论慢性重型肝炎患者免疫功能下降，术后未合并脓毒症者免疫状态于术后7—14d开始逐渐改善，发生脓毒症者仍维持术前的免疫低下状态。Objective To investigate immune status changes in liver transplant patients suffering from early developed sepsis. Methods In this study 19 patients undergoing liver transplantation for severe hepatitis from Oct 2008 to Jul 2009 were enrolled. Immune status was compared between patients of severe hepatitis and 20 healthy volunteers. According to whether early sepsis developed or not, patients were divided into sepsis group （HSS） and non-sepsis group （HSNS）. T lymphocyte subgroups of the peripheral blood were compared between post-transplant and pre-transplant in these two groups on different stages. Results Comparing to volunteers, T% and IFN-γ/IL-4 of severe hepatitis patients significantly decreased, CD4 ＋ CD25 ＋ Foxp3 ＋ Treg（ % ）, Foxp3 mRNA and IL-10 significantly increased. Early sepsis developed in 9 patients. Compared with pre-transplant levels, T% in both groups significantly decreased on the first day post transplant. T% in HSNS group increased to the level of pretransplant while T% of HSS group remained at the low level. Treg% （ t = 3. 265, P = 0. 004） and Foxp3 mRNA （ t = 2. 750, P = 0. 013 ） of HSNS group on day 14 decreased significantly lower than that before transplantation. Those two parameters of HSS group even increased slightly. IFN-γ/IL-4 in HSNS group increased significantly on day 3 （ t = 2. 261, P = 0. 036 ）, while there was no change in HSS group. The concentration of IL-10 in both groups significantly decreased, and the level in HSNS group remained at a low level, while that in HSS group increased on day 14. Conclusions Patients with severe hepatitis have weakened immune status. The imbalance of immune status recovers gradually since 7 - 14 days after transplantation in patients uncomplicated with sepsis. However, the immune status of receipients complicated with sepsis fails to improve.

关 键 词：肝移植 脓毒症 免疫抑制 T淋巴细胞 调节性 

分 类 号：R657.3[医药卫生—外科学]