免疫调理对结石性梗阻性黄疸术后感染并发症的防治作用  

Prevention and cure effect of immunoregulation therapy on postoperative infectious complications of cal-culous obstructive jaundice

作　　者：纪任[1] 倪勇[1] 章静[1] 邓浩源[1] 张敏杰[1] 韩庆[1] 王成友[1] 

机构地区：[1]深圳市第二人民医院肝胆外科,518035

出　　处：《中华肝胆外科杂志》2012年第11期851-854,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：深圳市科技局立题课题（201003045）

摘　　要：目的探讨免疫调理对梗阻性黄疸患者术后感染并发症的防治作用及作用机理。方法采用前瞻、随机、单盲、对照临床研究分析40例结石性梗阻性黄疸患者。患者按随机原则分为对照组和治疗组各20例。对照组给予常规治疗。治疗组给予常规治疗联合使用蛋白酶抑制剂和胸腺肽a1（常规治疗＋免疫调理），免疫调理疗程为7d。分别观察治疗前及治疗后1、3、5、7及14d淋巴细胞计数和CDl4’单核细胞人白细胞DR抗原（HLA—DR）水平等相关免疫学指标动态变化，同时收集临床术后感染资料。结果治疗组发生感染并发症2例，发生率10％。对照组发生感染并发症6例，发生率30％。两组感染并发症发生率差异有统计学意义（P〈0．01）。治疗组淋巴细胞计数及CDl＋’单核细胞HLA—DR水平在术后3d较对照组显著升高，并持续至治疗后14d（P〈0．05）。结论免疫调理可以升高淋巴细胞计数和CDl4＋。单核细胞HLA-DR水平，从而改善免疫麻痹，临床上可有效降低梗阻性黄疸患者术后感染并发症发生率。Objective To study the prevention and cure effect of immunoregulation therapy on postoperative infectious complications of calculous obstructive jaundice. Methods Prospective, ran- domized, blind and controlled clinical analysis of 40 patients conforming to the standard of calculous obstructive jaundice was carried out. The patients were divided into two groups at random. One was control group （n=20） with regular therapy, and the treatment group （n=20） with ulinastatin plus thymosin-al on the base of regular therapy for 1 week. The immunological indexes were determined before and after therapy on the 1st, 3rd, 5th. Tth and 14th day, including the changes in lymphocyte count, CD14＋ monocytes human leukocyte antigen （locus） DR （HLA-DR）, and the incidence of post- operative infection were observed. Results The incidence of postoperative infectious complications in treatment group （10%） was remarkable lower than that in control group （30%, P〈0.01）. There was significant difference between two groups （P〈0. 05）. After the 3rd, up to 14th day of therapy, the counts of lymphocyte and CD14＋ monocytes HLA-DR were significantly higher than those in con- trol group （all P〈0.05）. Conclusions Immunoregulation therapy can improve the prognosis of ob- structive jaundice patients in a period of 14 days of observation, and lymphocyte counts and CD14＋ monocytes HLA-DR were increased significantly, showing that immuno suppression can be ameliora- ted. Immunoregulation therapy could effectively prevent infectious complications of calculous obstruc- tive jaundice.

关 键 词：胆汁淤积 免疫疗法 感染 

分 类 号：R657.4[医药卫生—外科学]