肝硬化脾切除患者外周血T淋巴细胞亚群的变迁及其免疫功能变化

摘要/Abstract

摘要： 目的了解肝硬化患者行脾切除术后外周T淋巴细胞亚群的变迁,分析其免疫功能情况。方法采用流细胞术检测75例肝硬化患者脾脏切除前后外周血总T细胞及其各亚群细胞的绝对含量。结果与脾切除前相比较,脾切除后患者T淋巴细胞绝对含量显著降低(t=4.57,P<0.01);CD3阳性T细胞、CD4阳性T细胞及CD8阳性T细胞百分含量显著降低,分别由切除前的(63.47±6.45)%、(33.08±3.05)%、(22.45±7.85)%降至(48.62±5.85)%,(26.28±3.87)%及(15.89±4.84)%,差异有统计学意义(t值分别为8.67、5.32、5.87,P均<0.01);而CD4/CD8比值由(1.47±0.43)升至(1.69±0.53),差异有统计学意义(t=2.58,P<0.05)。脾切除前白细胞分化抗原CD3<50％ 6例;CD4<27％ 15例,CD8<15％ 11例;CD4/CD8<0.71 4例;脾切除后CD3<50％ 28例,CD4<27％ 38例,CD8<15％ 24例,CD4/CD8<0.71占6.7%(5例);与脾切除前相比较,脾切除后CD3阳性、CD4阳性及CD8阳性淋巴细胞亚群异常率显著升高(t值分别为3.59、6.44及4.89,P<0.01)。此外,与脾切除前相比,脾切除后其T淋巴细胞分泌的一系列细胞因子如IL-2、IL-4、IFN-γ及TNF-α均显著低于脾切除前。结论肝硬化脾切除患者存在明显的T细胞免疫功能紊乱,各亚群胞数量显著降低,CD3阳性T细胞明显下降,CD4阳性T细胞相对于CD8阳性细胞的功能亢进,随着病情加重CD4阳性T细胞的免疫应答能力进一步减退。

关键词: 肝硬化, 脾切除, T细胞亚群, 免疫功能

Abstract: Objective To investigate the alteration of peripheral blood T lymphocyte subsets and varied immune function in liver cirrhosis patients after splenectomy. Methods The absolute quantity of peripheral blood T lymphocyte subsets was detected using flow cytometry in 75 patients with liver cirrhosis before and after splenectomy. Results Compared with the prior to splenectomy, obviously decrease in absolute value of T cell was received in patients after splenectomy. The percentages of CD3+, CD4+ and CD8+ T cells were decreased from (63.47±6.45)%, (33.08±3.05)%, (22.45±7.85)% to (48.62±5.85)%, (26.28±3.87)%, (15.89±4.84)% respectively. However, CD4+/CD8+ ratio rose dramatically from (1.47±0.43) to (1.69±0.53) (t=P<0.05). The percentage of patients, which the frequencies of CD3+, CD4+ and CD8+ T cells were less than 50%, 27%, and 15% respectively, was increased from 8%, 20% and 14.7% to 37.3%, 50.7% and 32%, respectively. Additionaly, the percentage of patients with CD4/CD8<0.71 increased from 5.3% to 6.7%. Compared to before splenectomy, abnormal percentage of lymphocyte subsets after splenectomy, including CD3+、CD4+ and CD8+, was increased significantly (t=3.59, 6.44 and 4.89 respectively, all P<0.01), meanwhile the levels of cytokines secreted by T cells after splenectomy, including IL-2, IL-4, IFN-γ and TNF-a, were decreased significantly. Conclusion There might be immune disorders in liver cirrhosis patients after splenectomy, such as apparent reduction in quantity of T lymphocyte subsets and hyperfunction of CD4+ T cell compared to CD8+ T cell. As the disease condition aggravates, the immune response ability of CD4+ T cell could be further weaken. Patients after splenectomy showing significant abnormality of lymphocyte subsets should be alert to the occurrence of tumor or infection.

Key words: Liver cirrhosis, Splenectomy, T-cell subsets, Immune function

郭婷婷. 肝硬化脾切除患者外周血T淋巴细胞亚群的变迁及其免疫功能变化[J]. 肝脏, 2016, 21(9): 726-728.

Guo Ting-ting. Alteration of T-cell subsets in peripheral blood and immunologic function in liver cirrhosis patients with splenectomy[J]. Chinese Hepatolgy, 2016, 21(9): 726-728.

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