脾功能亢进患者行脾切除术与部分脾动脉栓塞术前后免疫功能的对比研究
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摘要
目的:研究脾切除术与部分脾动脉栓塞术对脾功能亢进患者的影响。方法:选取我院外科确诊为乙型病毒性肝炎后肝硬化伴脾功能亢进症患者38例,通过随机数表法将所有患者平分为观察组和对照组,观察组给予部分脾动脉栓塞术,对照组给予脾切除术。检测术前术后血细胞计数、细胞免疫指标和体液免疫指标。结果:术后7天,对照组的红细胞略低于实验组(X~2=0.118,P=0.906);对照组的白细胞高于实验组(X~2=6.095,P<0.001);对照组的血小板显著低于实验组(X~2=17.263,P<0.001);术后28天,对照组的红细胞显著低于实验组(X~2=7.981,P<0.001);对照组的白细胞明显高于实验组,差异有统计学意义(X~2=4.862,P<0.001);对照组的血小板低于实验组(X~2=2.165,P=0.037);术后7天,对照组的CD3略低于实验组(t=0.606,P=0.548),对照组的CD4明显低于实验组,CD8显著高于实验组,CD4/CD8低于实验组,差异均有统计学意义(P<0.001);术后28天,对照组的CD3略低于实验组(t=0.948,P=0.349);对照组的CD4略低于实验组(t=2.742,P=0.009);对照组的CD8显著高于实验组,CD4/CD8低于实验组,差异均无统计学意义(P>0.05);术后7天,对照组的IgM高于实验组,对照组的IgG略高于实验组,IgA低于对照组,但差异无统计学意义(P>0.05);术后28天,对照组的IgM高于实验组,对照组的IgG略高于实验组,但差异无统计学意义(P>0.05);对照组的IgA为(2.76±1.37)g/L,明显低于实验组的(3.79±1.69)g/L(t=2.063,P=0.046)。结论:部分脾动脉栓塞术能有效改善脾亢症状,调节脾脏功能,提升全身性免疫功能,值得在临床中推广。
Objective: To study the effects of splenectomy and partial splenic artery embolization on patients with hypersplenism.Methods: In this study included were 38 cases of patients diagnosed with liver cirrhosis after viral hepatitis B and hypersplenism in our hospital. By the method of random number table, they were divided into the observation group and the control group. The observation group was given partial splenic artery embolization, and the control group was treated with splenectomy. Blood cell count, cellular immunity and humoral immunity were detected before and after operation. Results: On the 7th day after operation, the red blood cell level in the control group was slightly lower than in the experimental group(X~2=0.118, P=0.906); The white blood cell level in the control group were higher than in the experimental group(X~2=6.095, P<0.001); and the platelet in the control group was significantly lower than in the experimental group(X~2=17.263, P<0.001). After 28 days, the red blood cell level in control group was significantly lower than in the experimental group(X~2=7.981, P<0.001); while white blood cell levels in the control group was significantly higher than that in the experimental group, and difference had statistical significance(X~2=4.862, P<0.001). The platelet in control group remained lower than in the experimental group(X~2=2.165, P=0.037). At 7 days after surgery, the CD3 level in the control group was slightly lower than in the experimental group(t=0.606, P=0.548), and the CD4 level was significantly lower than in the experimental group, but CD8 level was significantly higher than in the experimental group. The CD4/CD8 was lower in the control group than in the experimental group. All the differences were statistically significant(P<0.001). The IgM was higher, and the IgG slightly higher, but IgA lower in control group than in the experimental group, but the differences were not statistically significant(P>0.05). After 28 days, the CD3 and CD4 were slightly lower in the control group than in the experimental group(t=0.948, P=0.349; t=2.742, P=0.009), while the CD8 was significantly higher in the control group than in the experimental group, and CD4/CD8 was lower than that of the experimental group. All the differences were not statistically significant(P>0.05). The IgM was higher and IgG was slightly higher in the control group than in the experimental group, but the differences were not statistically significant(P>0.05). The IgA was(2.76±1.37)g/L in the control group, but(3.79±1.69)g/L in the experimental group. The IgA was significantly lower in the control group than in the experimental group(t=2.063, P=0.046).Conclusion: Partial splenic embolization can effectively improve the symptoms of hypersplenism, regulate spleen function, and enhance the body immunity, so it is worthy of clinical promotion.
Objective: To study the effects of splenectomy and partial splenic artery embolization on patients with hypersplenism.Methods: In this study included were 38 cases of patients diagnosed with liver cirrhosis after viral hepatitis B and hypersplenism in our hospital. By the method of random number table, they were divided into the observation group and the control group. The observation group was given partial splenic artery embolization, and the control group was treated with splenectomy. Blood cell count, cellular immunity and humoral immunity were detected before and after operation. Results: On the 7th day after operation, the red blood cell level in the control group was slightly lower than in the experimental group(X~2=0.118, P=0.906); The white blood cell level in the control group were higher than in the experimental group(X~2=6.095, P<0.001); and the platelet in the control group was significantly lower than in the experimental group(X~2=17.263, P<0.001). After 28 days, the red blood cell level in control group was significantly lower than in the experimental group(X~2=7.981, P<0.001); while white blood cell levels in the control group was significantly higher than that in the experimental group, and difference had statistical significance(X~2=4.862, P<0.001). The platelet in control group remained lower than in the experimental group(X~2=2.165, P=0.037). At 7 days after surgery, the CD3 level in the control group was slightly lower than in the experimental group(t=0.606, P=0.548), and the CD4 level was significantly lower than in the experimental group, but CD8 level was significantly higher than in the experimental group. The CD4/CD8 was lower in the control group than in the experimental group. All the differences were statistically significant(P<0.001). The IgM was higher, and the IgG slightly higher, but IgA lower in control group than in the experimental group, but the differences were not statistically significant(P>0.05). After 28 days, the CD3 and CD4 were slightly lower in the control group than in the experimental group(t=0.948, P=0.349; t=2.742, P=0.009), while the CD8 was significantly higher in the control group than in the experimental group, and CD4/CD8 was lower than that of the experimental group. All the differences were not statistically significant(P>0.05). The IgM was higher and IgG was slightly higher in the control group than in the experimental group, but the differences were not statistically significant(P>0.05). The IgA was(2.76±1.37)g/L in the control group, but(3.79±1.69)g/L in the experimental group. The IgA was significantly lower in the control group than in the experimental group(t=2.063, P=0.046).Conclusion: Partial splenic embolization can effectively improve the symptoms of hypersplenism, regulate spleen function, and enhance the body immunity, so it is worthy of clinical promotion.
引文
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[4]Molica M,Massaro F,Annechini G,et al.Life-Threatening Autoimmune Hemolytic Anemia and Idhiopatic Thrombocytopenic Purpura.Successful Selective Splenic Artery Embolization[J].Mediterr J Hematol Infect Dis,2016,8(1):e2016020
[5]Yuan Li-li,Zhu Xi-qi,Dai Feng,et al.Two different splenic embolization clinical outcome control study[J].Journal of southeast university(medical edition),2015,55(2):247-250
[6]Ji Guang-xi,Guo Yong-hong,Ma Li,et al.The recent advances in the treatment of viral hepatitis cirrhosis of the liver and spleen function[J].Modern biomedical progress,2014,14(21):4176-4179
[7]Jin GY,Lv CZ,Tang D,et al.Effect of partial splenic embolization on the immune function of cirrhosis patients with hypersplenism[J].Asian Pac J Trop Med,2016,9(7):702-706
[8]S覬nder SU,Limgala RP,Ivanova MM,et al.Persistent immune alterations and comorbidities in splenectomized patients with Gaucher disease[J].Blood Cells Mol Dis,2016,59(12):8-15
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[10]Lu LS,Hung FC,Chuah SK,et al.Recurrent gastric varices bleeding after living-related liver transplantation successfully eradicated by splenic artery embolization[J].Hepato-gastroenterology,2012,59(117):1586-1588
[11]Maurer MH,Mogl MT,Podrabsky P,et al.Splenic artery syndrome after orthotopic liver transplantation:Treatment with the amplatzer vascular plug[J].Cardiovascular and Interventional Radiology:A Journal of Imaging in Diagnosis and Treatment,2011,34(6):1208-1213
[12]Pirasteh A,Snyder LL,Lin R,et al.Temporal assessment of splenic function in patients who have undergone percutaneous image-guided splenic artery embolization in the setting of trauma[J].Journal of vascular and interventional radiology:JVIR,2012,23(1):80-82
[13]Bessoud B,Duchosal MA,Siegrist CA,et al.Proximal splenic artery embolization for blunt splenic injury:clinical,immunologic,and ultrasound-Doppler follow-up.[J].The Journal of trauma,2007,62(6):1481-1486
[14]Lu XX,Shen Z,Dong KR,et al.Hypersplenism Associated With Late-Presenting Congenital Diaphragmatic Hernia:A Rare Combination.Case Report[J].Medicine(Baltimore),2016,95(21):e3707
[15]Olthof DC,Lammer,AJJ,van Leeuwen EMM,et al.Antibody Response to a T-Cell-Independent Antigen Is Preserved after Splenic Artery Embolization for Trauma[J].Clinical and vaccine immunology:CVI,2014,21(11):1500-1504
[16]Saddekni S,Moustafa AS,Tahoon HA,et al.Treatment of Hypersplenism by Partial Splenic Embolization Through Gastric Collaterals[J].J Radiol Case Rep,2016,10(3):28-35
[17]Mitchell Smith,Charles E.Ray.Splenic Artery Embolization as an Adjunctive Procedure for Portal Hypertension[J].Seminars in interventional radiology,2012,29(2):135-139
[18]Mitchell O,Feldman DM,Diakow M,et al.The pathophysiology of thrombocytopenia in chronic liver disease[J].Hepat Med,2016,8(12):39-50
[19]Tsutsumi N,Tomikawa M,Akahoshi T,et al.Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis:effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications[J].Am J Surg,2016,6(4):23-27
[20]He Xin-hong,Gu Jian-jian,Li Wen-tao,et al.Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism[J].World journal of gastroenterology:WJG,2012,18(24):3138-3144
[2]Gu JJ,He X H,Li W T,et al.Safety and efficacy of splenic artery coil embolization for hypersplenism in liver cirrhosis[J].Acta Radiologica,2012,53(8):862-867
[3]Ou MC,Chuang MT,Lin XZ,et al.A novel method for the angiographic estimation of the percentage of spleen volume embolized during partial splenic embolization[J].European Journal of Radiology,2013,82(8):1260-1265
[4]Molica M,Massaro F,Annechini G,et al.Life-Threatening Autoimmune Hemolytic Anemia and Idhiopatic Thrombocytopenic Purpura.Successful Selective Splenic Artery Embolization[J].Mediterr J Hematol Infect Dis,2016,8(1):e2016020
[5]Yuan Li-li,Zhu Xi-qi,Dai Feng,et al.Two different splenic embolization clinical outcome control study[J].Journal of southeast university(medical edition),2015,55(2):247-250
[6]Ji Guang-xi,Guo Yong-hong,Ma Li,et al.The recent advances in the treatment of viral hepatitis cirrhosis of the liver and spleen function[J].Modern biomedical progress,2014,14(21):4176-4179
[7]Jin GY,Lv CZ,Tang D,et al.Effect of partial splenic embolization on the immune function of cirrhosis patients with hypersplenism[J].Asian Pac J Trop Med,2016,9(7):702-706
[8]S覬nder SU,Limgala RP,Ivanova MM,et al.Persistent immune alterations and comorbidities in splenectomized patients with Gaucher disease[J].Blood Cells Mol Dis,2016,59(12):8-15
[9]Nag HH,Chandrasekar S,Manipadum JM,et al.Laparoscopic splenic artery ligation for hypersplenism in cirrhosis:A case series[J].J Minim Access Surg,2016,32(8):45-47
[10]Lu LS,Hung FC,Chuah SK,et al.Recurrent gastric varices bleeding after living-related liver transplantation successfully eradicated by splenic artery embolization[J].Hepato-gastroenterology,2012,59(117):1586-1588
[11]Maurer MH,Mogl MT,Podrabsky P,et al.Splenic artery syndrome after orthotopic liver transplantation:Treatment with the amplatzer vascular plug[J].Cardiovascular and Interventional Radiology:A Journal of Imaging in Diagnosis and Treatment,2011,34(6):1208-1213
[12]Pirasteh A,Snyder LL,Lin R,et al.Temporal assessment of splenic function in patients who have undergone percutaneous image-guided splenic artery embolization in the setting of trauma[J].Journal of vascular and interventional radiology:JVIR,2012,23(1):80-82
[13]Bessoud B,Duchosal MA,Siegrist CA,et al.Proximal splenic artery embolization for blunt splenic injury:clinical,immunologic,and ultrasound-Doppler follow-up.[J].The Journal of trauma,2007,62(6):1481-1486
[14]Lu XX,Shen Z,Dong KR,et al.Hypersplenism Associated With Late-Presenting Congenital Diaphragmatic Hernia:A Rare Combination.Case Report[J].Medicine(Baltimore),2016,95(21):e3707
[15]Olthof DC,Lammer,AJJ,van Leeuwen EMM,et al.Antibody Response to a T-Cell-Independent Antigen Is Preserved after Splenic Artery Embolization for Trauma[J].Clinical and vaccine immunology:CVI,2014,21(11):1500-1504
[16]Saddekni S,Moustafa AS,Tahoon HA,et al.Treatment of Hypersplenism by Partial Splenic Embolization Through Gastric Collaterals[J].J Radiol Case Rep,2016,10(3):28-35
[17]Mitchell Smith,Charles E.Ray.Splenic Artery Embolization as an Adjunctive Procedure for Portal Hypertension[J].Seminars in interventional radiology,2012,29(2):135-139
[18]Mitchell O,Feldman DM,Diakow M,et al.The pathophysiology of thrombocytopenia in chronic liver disease[J].Hepat Med,2016,8(12):39-50
[19]Tsutsumi N,Tomikawa M,Akahoshi T,et al.Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis:effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications[J].Am J Surg,2016,6(4):23-27
[20]He Xin-hong,Gu Jian-jian,Li Wen-tao,et al.Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism[J].World journal of gastroenterology:WJG,2012,18(24):3138-3144