摘要
目的观察术前胆道引流恶性阻塞性黄疸患者免疫、炎症状况的影响。方法选择2006年3月至10月我科住院的恶性阻塞性黄疸手术患者22例,按照术前胆道引流与否分为减黄组(PBD)和未减黄组(NPBD),另取10例胆囊结石或肝血管瘤手术患者作为正常对照组,观察引流前、引流后、术后1d、7d指标,包括肝功能指标ALT、AST、TB、DB、ALP、GGT以及免疫、炎症反应指标IL-6、IL-8、TNF-α、CD4+、CD8+、CRP。结果术前胆道引流使13例患者的ALT、AST、GGT、TB下降。恶性阻黄组的IL-8水平较正常对照组的高[(1.330±0.334)μg/Lvs(0.331±0.095)μg/L,P<0.05];恶性阻黄组的TNF-α水平较正常对照组的高([1.450±0.270)μg/Lvs(0.644±0.112)μg/L,P<0.05]。引流后TNF-α水平较引流前显著降低,为(1.060±0.212)μg/L;术后7d时PBD组TNF-α水平为(0.793±0.251)μg/L,较术前差异性有统计学意义;非引流组术后7d时TNF-α水平为(1.180±0.205)μg/L,较术前下降明显,差异有统计学意义(P<0.05)。恶性阻黄患者胆道引流前后CD4+、CD8+、CD4+/CD8+、CRP水平无差别,是否行胆道引流差别亦无统计学意义。结论术前胆道引流可降低恶性阻塞性黄疸的血清TNF-α水平;血清TNF-α水平可作为反应恶性阻塞性黄疸免疫、炎症反应状态较为敏感的因子。
Objective To investigate the effect of preoperative biliary drainage （PBD） on the immuno-inflammatory function in the patients with malignant obstructive jaundice（OJ）. Methods Twenty-two patients with malignant obstructive jaundice were selected from March, 2006 to Nov, 2006. Ten patients with cholecystohthiasis or liver hemangioma were selected as control group. The serum index was measured before and after PBD and on postoperative day 1, 7, which included liver function test（ALT, AST, TB, DB, ALP, GGT） and immunoinflammatory test（IL-6, IL-8, TNF-α, CD4＋, CD8＋, CRP）. Results PBD could reduce serum level of ALT, AST, TB, GGT in thirteen patients. The IL-8 level in OJ group was （1.330± 0.334） IX g/L and significantly higher than （0.331 ± 0.095） μg/L in control group. The TNF- α level was （1.450 ± 0.270） μg/L and significantly higher than （0.644 ± 0.112）μg/L in control group. The level of TNF- α was （1.06 ± 0.212） μg/L and significantly lower than the level before bihary drainage in the patients with OJ, the level of TNF- α was（0.793 ± 0.251） μg/L in PBD group on postoperative day 1,7, and significantly lower than the level before drainage. The level of TNF- α was （1.180 ± 0.205） μg/L and significantly lower than before operation in no PBD group. There was no significant difference between the level of CD4±, CD8±, CD4＋/CD8＋, CRP before and after drainage, and neither whether PBD or not. Conclusions Short term of PBD can reduce serum TNF- α in malignant obstructive jaundice patients. Serum TNF-α level can act as a sensitive factor to reflect immunoinflammatory state in the patients with obstructive jaundice.
出处
《中华普通外科学文献（电子版）》
2010年第2期26-29,共4页
Chinese Archives of General Surgery(Electronic Edition)
基金
中山大学5010项目(2007012)
关键词
阻塞性黄疸
恶性肿瘤
胆道引流
免疫
Obstructive jaundice
Malignant tumor
Biliary drainage
Immune
