超滤浓缩回输对肝硬化腹水患者自然杀伤T细胞及RAAS系统的影响  

Effect of ascites ultrafiltration-concentration back-transfusion treatment on the natural killer cells (NKT) and renal-angiotensin Ⅱ-aldosterone system (RAAS) for patients with cirrhotic refractory ascites

作　　者：詹建生[1] 陈淑娜[1] 谭永港[1] 熊鹰[1] 

机构地区：[1]深圳市第二人民医院消化内科,518035

出　　处：《现代消化及介入诊疗》2012年第3期133-137,共5页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的观察超滤浓缩回输对肝硬化腹水患者自然杀伤T细胞(NKT)及RAAS系统的影响。方法将90例肝硬化腹水患者随机分为观察组(n=60)及对照组(n=30),分别给予腹水超滤浓缩回输治疗及常规治疗;比较治疗前后外周血及腹水内NKT细胞及其胞内细胞因子IL-4及IFN-γ含量变化,比较血浆肾素、血管紧张素Ⅱ及醛固酮的变化。结果治疗前两组患者外周血及腹水NKT、IL-4及IFN-γ均不存在组间差异,治疗后两组患者上述6项指标均较治疗前上升,且治疗后观察组外周血及腹水的NKT及IFN-γ百分含量均显著高于对照组(P<0.05),但IL-4无组间差异。治疗前两组患者的肾素、血管紧张素Ⅱ及醛固酮均不存在组间差异。治疗后以上三项指标均呈不同程度下降,且观察组这三项指标较治疗前显著下降(P<0.05),但对照组仅血管紧张素Ⅱ及醛固酮较治疗前显著下降(P<0.05),而肾素无统计学差异。治疗后,观察组肾素、血管紧张素Ⅱ及醛固酮水平均明显低于对照组(P值分别为0.041、0.023及0.035)。相关性分析显示NKT及IFN-γ两者,与肾素、血管紧张素Ⅱ及醛固酮三者当中的任意一者均呈负相关性,(r均>0.6,P<0.05)。但IL-4与RAAS指标无相关性(P>0.05)。结论腹水超滤浓缩回输可增强NKT细胞及IFN-γ的活性,抑制RAAS激素活性,提示该方法具有免疫调节作用,是治疗肝硬化腹水患者的一个新机制。Objective To observe the impact of ascites reinfusion on natural killer T cells （NKT） and the RAAS system. Methods Ninety patients with cirrhosis were randomly divided into reinfusion group （n = 60） and control group （n = 30）, and were given ascites reinfusion therapy and conventional treatment, respectively; changes of NKT cells in peripheral blood and ascites as well as its intraceUular cytokines IL--4 and IFN-γ lev- els before and after treatment were compared, and the serum renin, angiotensin Ⅱ and aldosterone changes were also observed. Results Before treatment, NKT, IL--4 and IFN-γ in peripheral blood and ascites were not dif- ferent between the two groups. After treatment, NKT and IFN-γwere significantly higher in reinfusion group than in control group （P 〈 0.05）, but IL-4 levels had no difference between the two groups. Before treatment, there were no differences in serum renin, angiotensin Ⅱ and aldosterone levels between the two groups. After treatment, the three indicators showed different degrees of decline, and more significant in the reinfusion group （P 〈 0.05）, but there was no significant change in renin levels in the control group. However, renin, angiotensin Ⅱ and aldosterone in ascites were significantly lower in the reinfusion group than that in the control group （P = 0.041, 0.023 and 0.035）. NKT and IFN-γhad a negative correlation with renin, angiotensin Ⅱ, and aldosterone levels. However, IL-4 and RAAS index did not show any correlation （P 〉 0.05）. Conclusion Ascites-concen- tration reinfusion can enhance the activity of NKT cells and IFN-γwith the inhibition of the RAAS activity, suggesting it is a new mmunomodulatory mechanism for the treatment of patients with cirrhosis.

关 键 词：肝硬化 腹水 超滤浓缩 自然杀伤T细胞 肾素-血管紧张素Ⅱ-醛固酮系统 

分 类 号：R442.5[医药卫生—诊断学]