肝外胆管结石手术对人免疫缺陷病毒感染者细胞免疫的影响  

Effect of extrahepatic bile duct stone surgery on cellular immunity in HIV-infected patients

作　　者：魏国 赵勇 华欣 胡明辉 何永 刘林 蔡琳 何盛华 

机构地区：[1]成都市公共卫生临床医疗中心普通外科,四川成都610061 [2]成都市公共卫生临床医疗中心感染科,四川成都610061

出　　处：《实用医院临床杂志》2015年第2期73-76,共4页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科研基金资助项目(编号:20090013)

摘　　要：目的观察肝外胆管结石外科手术对不同免疫缺陷程度的肝胆结石患者细胞免疫功能的影响。方法统计36例人免疫缺陷病毒(Human immunodeficiency virus,HIV)阳性(HIV+)与同期42例HIV阴性(HIV-)共78例需行外科手术的肝外胆管结石患者术后切口感染、术后肺部感染、术后新发机会性感染等指标。检测其术前1天(D0)、术后第7天(D7)、术后第30天(D30)外周静脉血白细胞计数、中性粒细胞率、淋巴细胞率、T淋巴细胞亚群CD4、CD8计数;各自计算D7、D30两次CD4计数相对于D0百分比D7/D0(%)、D30/D0(%).并根据D0的CD4计数分层(组)。结果各组三次检测白细胞计数、中性粒细胞率、淋巴细胞率、CD8计数差异无统计学意义(P>0.05);CD4计数两两比较差异有统计学意义(P<0.05);不同组别之间差异有统计学意义(F=402.410,P<0.05);时间和组别两个因素之间有交互效应(F=13.497,P<0.05)。结论肝外胆管结石外科手术对以CD4为主的细胞免疫功能有"先抑制后恢复"的影响过程,HIV感染者免疫缺陷程度越重,其免疫抑制越明显,免疫恢复也更缓慢。正确把握手术适应证以及恰当的围术期处理前提下,合并HIV感染的肝外胆管结石患者施行手术可以取得与非HIV感染者类似满意的临床疗效.Objective To observe the effect of extrahepatic bile duct stone surgery on cellular immunity in patients with different degrees of human immunodeficiency virus（ HIV） infection. Methods The indicators such as postoperative wound infection,postoperative pulmonary infection and postoperative new opportunistic infection were compared between 36 patients with HIV＋ and 42 cases with HIV-who were required an extrahepatic bile duct stones surgery. The peripheral white blood cell count,rates of neutrophil or lymphocyte,and counts of T lymphocyte subsets CD4 and CD8were determined on day 1 before operation（ D0） and postoperative 7th（ D7）and 30 th days（ D30）. At the same time,the patients were grouped according to CD4 count on the D0. Results There was no significant difference in white blood cell count,neutrophil rate,lymphocyte rate and CD8 count in three times determinations within each group.However,there was a significant difference in CD4 counts between the two groups（ P〈0. 05）. The differences was statistically significant（ F = 402. 410,P〈0. 05）. Moreover,there was an interaction between two factors of time and group（ F = 13. 497,P〈0. 05）.Conclusion The extrahepatic bile duct stone surgery has an influence process of＂recovery after the first suppression＂on cellular immune function based upon CD4 cells. More serious immunodeficiency HIV＋ patients has,the more obvious immune suppression is. Further,immune recovery is slower. A satisfactory clinical efficacy for combined HIV-infected extrahepatic bile duct stone underwent surgery can be achieved similar to non HIV infection patients if the indications for surgery are correctly gasped with appropriate perioperative treatment.

关 键 词：人类免疫缺陷病毒 肝外胆管结石 CD4T淋巴细胞 

分 类 号：R364.25[医药卫生—病理学] R512.91[医药卫生—基础医学]