脾功能亢进与血脾屏障的研究  

Research between blood-spleen barrier and hypersplenism

作　　者：高庆轮[1] 邢岩伟[1] 朱安龙[1] 杜毅[1] 朴大勋[1] 姜洪池[1] 

机构地区：[1]哈尔滨医科大学附属第一医院普外科,150001

出　　处：《中华肝胆外科杂志》2013年第3期183-185,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的研究脾功能亢进时血脾屏障的改变，探讨两者的相关性和脾功能亢进的发病机理。方法收集33例肝硬化门静脉高压脾脏为试验组，20例外伤脾脏为对照组。每例脾脏选取5块组织，HE染色后计数生发中心，总生发中心数量一平均值×脾质量。统计脾脏质量，术前血常规数值。统计学计算生发中心数量与血常规数值的相关性。结果两组比较，试验组中血常规数值显著降低，脾质量增加（平均值764．2g），生发中心增多（平均值8817／例）。生发中心的总量与血小板计数呈负相关。说明脾功能亢进程度（包括血小板和脾质量）与生发中心数量的关系。即血小板数量越少，其脾脏生发中心的总数越多，脾质量越重，生发中心数量亦越多。结论肝硬化脾功能亢进时，脾脏中的生发中心显著增多，形态不完整，血脾屏障功能异常。血脾屏障功能异常是脾功能亢进的发病基础。Objective To study the morphological character of blood-spleen barrier in patients with hypersplenism, and to discuss the relevance and pathogenesis of hypersplenism. Methods The spleens of 33 patients with cirrhosis with portal hypertension were collected as the experimental group, and 20 patients with traumatic spleen as the matched group. Five pieces of tissues in each spleen were sampled. The samples were made into pathological sections, stained with H. E. and ex- amined microscopically for the total number of germinal centers （GC）. The data of patients before op- eration were collected which included： blood routine （count of RBC, WBC, PLT and HB） and splenic weight. The correlation of blood routine values and sum of GC was studied using relative linear analy- sis. Results In the experimental group.. The blood routine values were remarkably lower, splenic weight （average 764.2 g） and the quantity of the germinal center （average 8817/case） were higher. There was a reverse relationship between the total quantity of germinal centers and the PLT. There was a close relationship between the quantity of germinal center and the extent of the hypersplenism, i.e. the lower the preoperative platelet number, the greater the total number of germinal center; the heavier the splenic weight, the greater the number of germinal center. Conclusions The total number of germinal center increased dramatically in patients with cirrhosis with portal hypertension. The change is accompanied by changes in morphology of the germinal centers and dysfunction in blood- spleen barrier. It is likely that hypersplenism develops on the basis of dysfunction of blood-spleen barrier.

关 键 词：脾功能亢进 血小板计数 白细胞计数 

分 类 号：R575.2[医药卫生—消化系统]