摘要
目的:观察腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)对不同免疫缺陷程度的人免疫缺陷病毒(human immunodeficiency virus,HIV)感染者细胞免疫功能的影响.方法:62例HIV阳性(HIV+)与同期随机32例HIV阴性(HIV-)共94例需LC患者,检测其术前1 d(D0)、术后第3天(D3)、术后第7天(D7)外周静脉血T淋巴细胞亚群CD4和CD8计数(单位cell/μL).各自计算D3、D7两次CD4计数相对于D0百分比D3/D0(%)、D7/D0(%).并根据术前1 d(D0)CD4计数分层(组),Ⅰ≥500>Ⅱ≥200>Ⅲ≥0.SPSS19.0软件包分析每组内前后差异以及各层组之间差异.结果:在各组内部前后3次检测中,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计数各组内部前后3次检测两两对比差异有统计学意义(P<0.001).不同组别之间差异有统计学意义(F=203.80,P<0.001).时间和组别两个因素之间有交互效应(F=8.08,P<0.001).结论:LC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,其影响过程体现出从HIV-Ⅰ组的"V"型到HIV+Ⅲ组的"L"型的渐变规律.HIV感染者免疫缺陷程度越重,其免疫抑制越明显,其免疫恢复也更缓慢.对HIV感染者施行手术需要正确把握手术适应症、重视免疫干预并且进行有针对性的围术期处理.
AIM： To observe the impact of laparoscopic cho- lecystectomy （LC） on cellular immunity in HIVinfected patients with different levels of immu- nodeficiency. METHODS： Ninety-four patients who underwent LC, including 62 HIV-positive （HIV＋） patients and 32 randomly selected HIV-negative （HIV-） patients, were included in the study. Peripheral venous blood samples were collected to count the number of CD4＋ （cell/pL） and CD8＋ （cell/uL） T lymphocyte subsets on preoperative day 1 （DO） and postoperative days 3 （D3） and 7 （D7）. The ratios of the number of CD4＋ cells on D3 to that on DO [D3/D0 （%）] and D7 to DO [D7/ DO （%）] were calculated. Patients were stratifiedinto three groups according to the count of CD4＋ cell count on DO： I （≥ 500）, II （I〉 200 but 〈 500） and III （≥ 0 but 〈 200）. The differences in the cell count between preoperation and postoperation in each group and between each group were analyzed by statistical methods. RESULTS： There were no significant differences in WBC count, neutrophil percentage, lymphocyte percentage and CD8＋ cell count between preoperation and postoperation in each group （P 〉 0.05 for all）, but significant differences were observed in CD4＋ cell count between preoperation and postoperation in each group （P 〈 0.001 for all） as well as between different groups （F = 203.80, P 〈 0.001）. There was an interactive effect between time and group （F = 8.08, P 〈 0.001）. CONCLUSION： LC has an impact on CD4-based cellular immunity, with a process from suppression to restoration. The more serious the immunodeficiency, the more significant the immunosuppression and the more slow the immune recovery. Attention should be paid to surgical indications and appropriate perioperative management including immune intervention in HIV- infected patients undergoing surgery.
出处
《世界华人消化杂志》
CAS
北大核心
2014年第5期700-704,共5页
World Chinese Journal of Digestology
基金
四川省卫生厅科研基金资助项目
No.20090013~~
