同期肝癌射频消融联合Hassab手术对肝细胞癌合并门静脉高压患者细胞免疫功能的影响  

Effects of radiofrequency ablation of liver cancer combined with Hassab operation on the cellular immune function of patients with hepatocellular carcinoma and portal hypertension

作　　者：贾哲 赫嵘 黄容海 鲁岩 王杨 蒋力 Jia Zhe;He Rong;Huang Ronghai;Lu Yan;Wang Yang;Jiang Li(Department of General Surgery,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院普外科,北京100015

出　　处：《中国肝脏病杂志（电子版）》2022年第3期61-67,共7页Chinese Journal of Liver Diseases：Electronic Version

基　　金：国家自然科学基金项目(31970566);首都卫生发展科研专项项目(2018-1-2081)。

摘　　要：目的探讨同期肝癌射频消融(radiofrequency ablation,RFA)联合Hassab手术对肝细胞癌(hepatocellular carcinoma,HCC)合并门静脉高压患者细胞免疫功能的影响。方法选择2018年1月至2019年6月就诊于首都医科大学附属北京地坛医院的47例HCC合并肝硬化门静脉高压的患者为研究对象。按照不同手术方式分为试验组(28例)和对照组(19例),试验组采用肝癌RFA联合Hassab术,对照组采用肝癌切除联合Hassab术。分别留取患者术前、术后3 d、术后4周外周血。采用流式细胞术检测外周血T细胞亚群(CD4+、CD8+、CD4+/CD8+),采用酶联免疫吸附实验测定外周血Th1细胞因子和Th2细胞因子,Th1细胞因子包括干扰素γ(interferonγ,IFNγ)、白细胞介素(interleukin,IL)-2、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α),Th2细胞因子包括IL-4和IL-8。比较不同手术方式对患者细胞免疫功能的影响。结果试验组和对照组患者术前CD4+T细胞(中位数:29.80%vs 29.50%)、CD8+T细胞(中位数:23.60%vs 24.30%)及CD4+/CD8+T细胞(中位数:1.30%vs 1.23%)比例差异均无统计学意义(P>0.05);术后3 d和术后4周,试验组患者CD4+T细胞(术后3 d中位数:26.55%vs 21.80%;术后4周中位数:34.95%vs 33.30%)和CD4+/CD8+T细胞(术后3 d中位数:1.22%vs 0.87%;术后4周中位数:1.46%vs 1.23%)比例均显著高于对照组,CD8+T细胞比例(术后3 d中位数:22.25%vs 25.50%;术后4周中位数:24.20%vs 26.50%)显著低于对照组,差异均有统计学意义(P均<0.05)。与术前相比,试验组患者CD4+T细胞、CD8+T细胞比例于术后3 d显著下降,术后4周外周血CD4+T细胞、CD8+T细胞及CD4+/CD8+T细胞比例显著升高(P均<0.05);而对照组术后3 d CD4+T细胞及CD4+/CD8+T细胞比例同样先下降,然后于术后4周显著升高(P均<0.05)。对照组CD8+T细胞术后无下降,呈持续升高(中位数:24.30%vs 25.50%vs 26.50%)。同对照组比较,试验组患者各指标于术后3 d及术后4周皆有显著差异(P均<0.05)。试验组和�Objective To investigate the effects of radiofrequency ablation(RFA)combined with Hassab operation on cellular immune function of patients with hepatocellular carcinoma(HCC)and portal hypertension.Methods Total of 47 patients with hepatocellular carcinoma(HCC)and portal hypertension in Beijing Ditan Hospital,Capital Medical University from January 2018 to June 2019 were selected.The patients were divided into experimental group(28 cases)and control group(19 cases)according to different methods of surgery.Patients in experimental group were given RFA combined with Hassab operation and patients in control group were given liver cancer resection combined with Hassab operation.The peripheral blood were collected before surgery,3 d and 4 weeks after surgery,respectively.Peripheral T cell subsets(CD4+,CD8+,CD4+/CD8+)was detected by flow cytometry,Th1 cytokines and Th2 cytokines were detected by enzyme-linked immunosorbent assay.Th1 cytokines included interferonγ(IFNγ),interleukin(IL)-2 and tumor necrosis factor-α(TNF-α),and Th2 cytokines included IL-4 and IL-8.The effects of different surgical methods on cellular immunity of the patient were compared.Results There were no significant differences of CD4+T cells(median:29.80%vs 29.50%),CD8+T cells(median:23.60%vs 24.30%)and CD4+/CD8+T cells(median:1.30%vs 1.23%)between patients in experimental group and control group before surgery(all P>0.05).Three days and 4 weeks after operation,the proportion of CD4+T cells(3 d after operation,median:26.55%vs 21.80%;4 weeks after operation,median:34.95%vs 33.30%)and CD4+/CD8+T cells(3 d after operation,median:1.22%vs 0.87%;4 weeks after operation,median:1.46%vs 1.23%)were significantly higher than those of control group,CD8+T cell(3 d after operation,median:22.25%vs 25.50%;4 weeks after operation,median:24.20%vs 26.50%)was significantly lower than that of control group,the differences were all statistically significant(all P<0.05).Compared with those before operation,the proportion of CD4+T cells and CD8+T cells of patients in ex

关 键 词：肝细胞癌 射频消融术 HASSAB手术 脾切除术 细胞免疫 

分 类 号：R735.7[医药卫生—肿瘤]