摘要
目的分析血浆置换对肝癌术后不同严重程度高胆红素血症患者免疫功能的影响。方法选择2021-01-01/2024-12-31期间于赣州市人民医院就诊的肝癌切除术后高胆红素血症患者100例为研究对象,采用随机数字表法分为对照组(常规药物治疗,n=50)和观察组(常规药物治疗+血浆置换治疗,n=50),并根据高胆红素血症严重程度进行分组,对照组中轻度组12例,中度组25例,重度组13例;观察组中轻度组14例,中度组24例,重度组12例。采集所有受试者的空腹肘静脉血检测免疫功能等指标。采用广义估计方程(GEE)模型分析两组不同程度患者治疗前后免疫功能指标差异以及不同时点、组别、程度对相关评分的交互效应。结果与治疗前比较,治疗后两组的免疫功能、肝功能与凝血功能指标均明显改善。治疗前,随着高胆红素血症严重程度从轻度到重度递增,两组患者的免疫球蛋白A(IgA)、IgG、IgM、肝功能Child-Pugh评分、白蛋白-胆红素(ALBI)评分呈增加趋势,CD4^(+)/CD8^(+)比值呈下降趋势;治疗后,这一趋势在对照组与观察组中仍然存在。治疗后,观察组与对照组同一严重程度患者间的比较结果显示,观察组不同程度患者的IgA、IgG、IgM、Child-Pugh评分、ALBI评分均显著降低,CD4^(+)/CD8^(+)比值显著增大。观察组与对照组同一严重程度患者治疗前后的凝血、肝功能及免疫功能指标变化量比较结果显示,观察组不同程度患者的凝血、肝功能及免疫功能指标变化量均显著优于对照组。观察组临床总有效率显著高于对照组。GEE分析显示,随着高胆红素血症严重程度增加,IgA、IgG、IgM水平显著增加,CD4^(+)/CD8^(+)比值显著降低;与治疗前比较,治疗后IgA、IgG、IgM水平显著降低,CD4^(+)/CD8^(+)比值显著增加;观察组IgA、IgG、IgM水平下降幅度高于对照组,CD4^(+)/CD8^(+)比值上升幅度高于对照组;观察组在治疗后对轻度、中度、重度患者Child-Pugh评分、ALBI评分的改善效果优于对照组。结论血浆置换治疗可有效改善肝癌术后不同严重程度高胆红素血症患者的免疫功能、肝功能与凝血功能,具有重要临床价值。
Objective To analyze the effect of plasma exchange on immune function in patients with hyperbilirubinemia of different severity after liver cancer surgery.Methods A total of 100 patients diagnosed with hyperbilirubinemia following liver cancer resection at Ganzhou People’s Hospital from January 1,2021 to December 31,2024 were enrolled as the study participants.Using a random number table,they were assigned to either a control group(conventional drug therapy,n=50)or an observation group(conventional drug therapy+plasma exchange therapy,n=50).All patients were further categorized by hyperbilirubinemia severity as mild,moderate,or severe.The distribution within the control group was 12(mild),25(moderate),and 13(severe);the distribution within the observation group was 14(mild),24(moderate),and 12(severe).Fasting venous blood samples were collected from all participants to assess immune function and other indicators.Generalized estimating equation(GEE)models were used to analyze the differences in immune function indicators across different severity levels and between the two groups before and after treatment,as well as the interactive effects of time point,group,and disease severity on the relevant scores.Results Compared with the pre-treatment levles,the immune,liver,and coagulation function indicators in both groups were significantly improved after treatment.Before treatment,as hyperbilirubinemia severity increased from mild to severe,levels of immunoglobulin A(IgA),immunoglobulin G(IgG),immunoglobulin M(IgM),the Child-Pugh score for liver function,and the albumin-bilirubin(ALBI)score showed an upward trend,while the CD4^(+)/CD8^(+)ratio showed a downward trend in both groups.After treatment,this trend persisted in both the control group and the observation group.Post-treatment comparisons between patients of the same severity level in the two groups showed that the observation group had significantly lower IgA,IgG,IgM,Child-Pugh,and ALBI score,and a significantly higher CD4^(+)/CD8^(+)ratio than the control group.Furthermore,the magnitude of improvement in coagulation,liver,and immune function indicators was significantly greater in the observation group across all severity levels.The total clinical effectiveness rate was significantly higher in the observation group.GEE analysis showed that the levels of IgA,IgG,and IgM were significantly increased,while the CD4^(+)/CD8^(+)ratio was significantly decreased with the increase in the severity of hyperbilirubinemia.The levels of IgA,IgG,and IgM were significantly decreased and the CD4^(+)/CD8^(+)ratio was significantly increased after treatment.The decline in IgA,IgG,and IgM levels in the observation group was greater than that in the control group,and the increase in the CD4^(+)/CD8^(+)ratio was also greater.The observation group demonstrated superior improvement in Child-Pugh and ALBI scores for patients with mild,moderate,and severe disease after treatment compared to the control group.Conclusion Plasma exchange therapy can effectively improve the immune,liver,and coagulation functions of patients with hyperbilirubinemia of different severity levels following liver cancer surgery,thereby offering significant clinical benefits.
作者
曾春云
孙鹭
温茹春
吴宇婷
ZENG Chunyun;SUN Lu;WEN Ruchun;WU Yuting(Department of Blood Transfusion,Ganzhou People’s Hospital,Ganzhou 341000,China)
出处
《细胞与分子免疫学杂志》
北大核心
2026年第2期148-158,共11页
Chinese Journal of Cellular and Molecular Immunology
基金
江西省卫生健康委科技计划项目(20222ZDX7888)。
关键词
免疫功能
血浆置换
肝癌
高胆红素血症
immune function
plasma exchange
liver cancer
hyperbilirubinemia
