恶性重度梗阻性黄疸对机体免疫功能的影响及免疫增强剂的治疗作用  

Influence of malignant severe obstructive jaundice on immune function and therapeutic effects of immunopotentiator

作　　者：范卫东[1] 聂洪峰[1] 陈永兵[1] 孙伯洋[1] 梅建民[1] 

机构地区：[1]北京军区总医院肝胆外科,北京100700

出　　处：《肝胆胰外科杂志》2013年第1期35-38,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨恶性重度梗阻性黄疸对机体免疫功能的影响及免疫增强剂的治疗作用。方法选择我院2010年3月至2012年7月收治的无明显黄疸(TBil<17.1μmol/L)的胆石症患者(A组,无黄疸对照组,n=20),恶性非重度梗阻性黄疸患者(TBil17.1～342μmol/L)(B组,恶性非重度黄疸组,n=20),恶性重度梗阻性黄疸(TBil>342μmol/L)行经皮经肝穿刺胆管引流术(PTCD)患者(C组,恶性重度黄疸组,n=39)。其中C组又分成免疫增强剂治疗组(C1,n=18)和非治疗组(C2,n=21)。C1组PTCD术后当天开始给予注射用胸腺肽α-1,1.6 mg/d,皮下注射,连用7 d。比较各组血浆细胞因子(IL-2、IFN-α、TNF-α)、T淋巴细胞亚群(CD3+、CD4+、CD8+)和NK细胞百分率的变化。结果 C组CD3+、CD4+、CD8+、NK细胞百分率及IL-2明显低于A组(P<0.05),CD3+、CD8+百分率及IL-2明显低于B组(P<0.05);TNF-α、IFN-αC组明显高于A组和B组(P<0.05);B组CD3+、NK细胞百分率及IL-2明显低于A组(P<0.05);CD4+/CD8+比值各组间无明显差异。C1组CD3+、CD4+百分率,CD4+/CD8+比值及IL-2呈升高趋势,TNF-α、IFN-α呈降低趋势,胸腺肽α-1治疗后第5天CD3+、CD4+百分率明显高于C2组(P<0.05),第7天CD4+百分率、CD4+/CD8+比值、IL-2、IFN-α明显高于C2组(P<0.05),TNF-α明显低于C2组(P<0.05)。结论恶性梗阻性黄疸患者免疫功能降低,重度黄疸时免疫功能受损更加明显。免疫增强剂可明显改善恶性梗阻性黄疸患者的免疫功能。Objective To explore the influence of malignant severe obstructive jaundice （MSOJ） on the immune function and the therapeutic effects of immunopotentiator. Methods From March 2010 to July 2012, the patients with cholelithiasis but without obstructive jaundice （TBIL〈 17.1 μmol/L） （group A, no-jaundice control group, n=20）, the patients with malignant non-severe obstructive jaundice （TBi117.1-342 μmol/L） （group B, malignant non-severe obstructive jaundice group, n=20）, and the patients with MSOJ （TBi1〉342 μmol/L） （group C, MSOJ group, n=39） were enrolled in this study. All the patients in group C underwent percutaneous transhepatic cholangiography and drainage （PTCD）, who were subdivided into immunopotentiator treatment group （C1, n=18） and non-immunopotentiator treatment group （C2, n=21）. Group C1 was established by subcu- taneous injection of thymosin α -1, starting from the day after PTCD, 1.6 mg/d, 7 d. Serum levels of cytokines （IL-2, IFN-α, TNF-α）, T lymphocyte subsets （CD3＋, CD4＋, CD8＋） and NK cells were detected and compared between different groups. Results In group C, the percentages of CD3＋, CD4＋, CD8＋, NK and the serum level of IL-2 were lower than that in group A （P〈0.05）; the percentages of CD3＋ and CD8＋ and the serum level of IL-2 were lower than that in group B （P〈0.05）; the serum levels of TNF-α and IFN-α were higher than that in group A and B （P〈0.05）. The percentages of CD3＋ and NK and the serum level of IL-2 in group B were lower than that in group A（P〈0.05）. There were no significant differences for the ratio of CD4＋/CD8＋ between different groups. In group C1, The percentages of CD3＋ and CD4＋, the ratio of CD4＋/CD8＋ and the serum level of IL-2 had an upward trend, the serum levels of TNF-α and IFN-α had a downward trend; the percentages of CD3＋ and CD4＋ were higher than that in group C2 on the fifth day after thymosin α -1 treatment （P〈0.05）; CD4＋ percentage, CD4/CD8�

关 键 词：恶性重度梗阻性黄疸 免疫功能 免疫增强剂 细胞因子 T淋巴细胞亚群 炎症 

分 类 号：R735[医药卫生—肿瘤]