胆总管结石患者术后T淋巴亚群变化及其与术后发生感染的关系  

Changes of T lymphocyte subsets in patients with choledocholithiasis after operation and its relationship with postoperative infection

作　　者：孟维山 苏忠[1] 吴维兴 MENG Wei-shan;SU Zhong;WU Wei-xing(Departmeng of General Surgery,First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市第一医院普通外科,河北秦皇岛066000

出　　处：《川北医学院学报》2023年第5期652-655,共4页Journal of North Sichuan Medical College

基　　金：河北省秦皇岛市科学技术研究与发展计划项目(202004A042)。

摘　　要：目的:探讨胆总管结石患者术后T淋巴亚群变化及其与术后发生感染的关系。方法:选取301例行腹腔镜联合胆道镜取石术治疗的胆总管结石患者为研究对象,依据术后是否发生感染分为感染组(n=43)和未感染组(n=258)。比较两组患者术前及术后1 d T淋巴细胞亚群水平,分析其与术后发生感染的关系。结果:术后1 d,两组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均较术前降低(P<0.05),且感染组CD4^(+)、CD4^(+)/CD8^(+)水平低于未感染组(P<0.05);CD8^(+)水平均较术前升高(P<0.05),且感染组高于未感染组(P<0.05)。术后1 d时,外周血CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平预测患者发生感染的ROC曲线下面积(AUC)分别为0.724、0.686、0.821,其中CD4^(+)/CD8^(+)水平预测效能高于CD4^(+)或CD8^(+)(P<0.05)。Logistic回归分析显示,糖尿病、操作时间≥150 min、术后1 d CD8^(+)高水平是发生术后感染的危险因素;术后1 d CD4^(+)、CD4^(+)/CD8^(+)高水平则是预防术后感染的保护因素。结论:胆总管结石行腹腔镜联合胆道镜取石术后1 d CD4^(+)、CD4^(+)/CD8^(+)低表达及CD8^(+)高水平可增大术后感染风险,可作为术后感染风险预测指标之一。Objective:To investigate the changes of T lymphocyte subsets in patients with choledocholithiasis and its relationship with postoperative infection.Methods:43 patients with postoperative infection after laparoscopic combined with choledochoscopy for choledocholithiasis was included in the infection group,the non-infected group consisted of 258 patients who did not develop infection after surgery.The changes of T lymphocyte subsets before and 1 day after operation were observed,and the relationship between T lymphocyte subsets and postoperative infection was analyzed.Results:The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)decreased and the level of CD8^(+)increased 1 day after operation in infected group and uninfected group(P>0.05).The levels of CD4^(+)and CD4^(+)/CD8^(+)in the infected group were lower than those in the uninfected group at 1 day after operation,and the level of CD8^(+)was higher than that in the uninfected group(P<0.05).The area under ROC curve of peripheral blood CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in predicting infection in patients was 0.724,0.686 and 0.821,respectively,and the evaluation efficacy of CD4^(+)/CD8^(+)was higher than that of CD4^(+)and CD8^(+)(P<0.05).Logistic regression analysis showed that diabetes,operation time≥150 min and high expression of CD8^(+)on the 1st day after operation were risk factors for postoperative infection in patients with common bile duct stones.High expression of CD4^(+)and CD4^(+)/CD8^(+)on the 1st day after operation were protective factors for preventing postoperative infection.Conclusion:The low expression of CD4^(+),CD4^(+)/CD8^(+)and high expression of CD8^(+)at 1 day after laparoscopic combined with choledochoscopy for choledocholithiasis can increase the risk of postoperative infection.The level of T lymphocyte subsets can be used as one of the predictors of postoperative infection risk.

关 键 词：胆总管结石 手术 术后感染 T淋巴细胞 免疫 

分 类 号：R657.[医药卫生—外科学]