原发性大隐静脉曲张传统开放性手术与激光治疗联合泡沫硬化术对机体免疫系统影响的比较  

Comparison of the effects between traditional open surgery and laser treatment combined with foam sclerotherapy on immune system in patients with primary great saphenous varicose veins

作　　者：何川 丁洋[2] 顾俊菲 万圣云[2] He Chuan;Ding Yang;Gu Junfei;Wan Shengyun(Department of Intervention,the Second Affiliated Hospital of Wannan Medical College,Wuhu 241000,China;不详)

机构地区：[1]皖南医学院第二附属医院介入科,芜湖241000 [2]安徽医科大学第二附属医院血管与胃肠外科,合肥230601

出　　处：《新医学》2023年第9期639-643,共5页Journal of New Medicine

基　　金：2021年度安徽省卫生健康委科研项目重点项目(AHWJ2021a003);2021年度安徽高校自然科学研究重点项目(KJ2021A0850)。

摘　　要：目的探讨原发性大隐静脉曲张传统开放性手术与激光治疗联合泡沫硬化术对机体免疫系统的影响。方法按照手术方式将104例择期行大隐静脉曲张手术的患者分为激光治疗联合泡沫硬术组(MIS组,53例)和传统开放性手术组(OS组,51例)。分别于术前和术后24 h采集2组静脉血测定超氧化物岐化酶(SOD)、IL-1β、IL-6、IL-8、IL-10、TNF-α、干扰素-γ(IFN-γ)水平。采用流式细胞术检测T淋巴细胞亚群及自然杀伤细胞(NK)的比例变化。采用单细胞测序(scRNA-seq)技术检测外周血免疫细胞差异基因表达。结果MIS组术后IL-1β、IL-8水平较术前高(P均<0.05),术前与术后的SOD、IL-6、IL-10、TNF-α、IFN-γ水平比较差异无统计学意义(P均>0.05);OS组上述指标术前与术后比较差异均有统计学意义(P均<0.05)。MIS组术前与术后T淋巴细胞亚群及NK比例比较差异均无统计学意义(P均>0.05);OS组术后24 h CD8^(+)T细胞比例升高,NK比例降低(P均<0.05)。术后24 h外周血免疫细胞表达差异基因功能富集分析提示OS组术后缺氧应答、IFN应答及NF-κB等炎症通路较MIS组上调。结论大隐静脉曲张激光治疗联合泡沫硬化术对机体系统免疫炎症及缺氧反应影响较小,能够更好地维持机体的免疫平衡,较大程度保留机体原有免疫系统抵御微生物入侵的能力。Objective To compare the effects of traditional open surgery and laser therapy combined with foam sclerotherapy on immune system in patients with primary saphenous varicose veins.Methods A total of 104 patients who underwent elective varicose vein surgery were divided into the laser therapy combined with foam sclerotherapy group(MIS group,n=53)and traditional open surgery group(OS group,n=51)according to the surgical method.Venous blood sample was collected before and 24 h after operation for the measurement of superoxide dismutase(SOD),interleukin(IL)-1β,IL-6 and IL-8,IL-10,tumor necrosis factor-α(TNF-α)and interferon-γ(IFN-γ)levels.The changes in the proportion of T cell subsets and NK cells were detected by flow cytometry.The expression levels of differentially-expressed genes(DEGs)of immune cells in peripheral blood were determined by single-cell RNA sequence(scRNA-seq)technology.Results In the MIS group,no significant differences were observed in the levels of SOD,IL-6,IL-10,TNF-αand IFN-γbefore and after operation(all P>0.05)except that IL-1βand IL-8 levels were increased after operation(both P<0.05).In the OS group,significant differences were noted in the above indicators before and after operation(all P<0.05).No significant differences were found in the proportion of T lymphocyte subsets and NK cells before and after surgery in the MIS group(both P>0.05),while the proportion of CD8^(+)T cells was increased at postoperative 24 h,and that of NK cells was significantly reduced in the OS group(both P<0.05).Functional enrichment analysis of the DEGs in peripheral blood immune cells at postoperative 24 h indicated that postoperative hypoxia response,IFN response,and NF-κB inflammatory signaling pathways in the OS group were significantly up-regulated compared with those in the MIS group.Conclusion Laser treatment combined with foam sclerotherapy exerts slight effect on the immune inflammation and hypoxic response of the body system in patients with primary saphenous varicose veins.MIS can better maint

关 键 词：原发性大隐静脉曲张 激光治疗 泡沫硬化术 炎症 免疫 缺氧 

分 类 号：R654.4[医药卫生—外科学]