后腹腔镜肾切除手术对免疫功能影响.docVIP

后腹腔镜肾切除手术对免疫功能影响 　 作者：白冰，徐华敏，母建君，雷弋 【摘要】 目的 使用流式细胞仪技术和ELISA法从T辅助细胞亚群（Th1/Th2）平衡角度和共刺激分子平衡角度评价后腹腔镜肾切除手术对术后免疫功能的影响。方法 择期肾切除患者26例，分别采用后腹腔镜手术和常规开放手术，测定手术前和术后3、24、48h，IL-4和INF-γ的水平及CD28和CTLA-4的表达。结果 开放手术组术后IL-4水平和CTLA-4表达明显升高，INF-γ水平和CD28表达下降，INF-γ/ IL-4比值下降，CD28/ CTLA-4明显下降。腹腔镜组术后各指标均无明显变化，与开放组差异显著。结论 常规开放肾切除手术可造成术后Th1/Th2平衡明显向Th2偏移和共刺激分子失衡，使抗炎反应占优势，造成明显的免疫抑制。而后腹腔镜手术对Th1/Th2平衡和共刺激分子平衡无显著影响，对术后免疫功能影响小。 【关键词】 后腹腔镜；Th1/Th2平衡；共刺激分子；免疫功能 Influence of retroperitoneal laparoscopic nephrectomy on immunological function ［Abstract］ Objective To investigate the immunological influences of retroperitoneal laparoscopic renal operation from the view of the balance of Th1 and Th2 cell detected by flow cytometry and costimulatory molecules by ELISA.Methods In optional 26 cases of patients with renal resection,the serum level of IL-4，INF-γ and CD28，CTLA-4 in 13 patients submitted to retroperitoneal laparoscopic renal operation（RLO） and 13 patients undergoing conventional open operation（COO）were evaluated preoperatively as well as 3，24，48 hours postoperatively.Results The level of INF-γ，CD28 and the INF-γ／IL-4 ratio decreased significant after the open surgery,but not after RLO.The postoperative level of CTLA-4 and IL-4 increased significant in COO group，but not RLO.The difference of the data in two groups was all significant.Conclusion The present study shows that open，but not retroperitoneal laparoscopic renal surgery is associated with a marked shift in Th1／Th2 balance to Th2 and a deregulation of the proinflammatory and anti-inflammatory balance.RLO has fewer influences on Th1／Th2 balance and immunologic suppression postoperatively. ［Key words］ retroperitoneal laparoscopy；Th1／Th2 balance;costimulatory molecules;immunological function 手术对机体免疫的影响主要表现为免疫抑制，免疫抑制易导致机体并发院内感染及肿瘤扩散，因此认识手术对机体免疫的影响极为重要，可预防或调节机体免疫，减少院内感染和肿瘤扩散。目前研究表明导致术后机体免疫抑制的因素有：组织损伤、麻醉和镇痛药物、体温降低、失血和输血、手术前后的焦虑和心理应激、疼痛等。但组织损伤的程度是决定免疫抑制强度和时间的主要因素。后腹腔镜肾切除手术以其创伤小、恢复快等优点近5年在国内逐渐开展，其与普通肾切除手术相比对术后免疫功能的影响国内外未见报道。近来发现，CD4+ 细胞亚群Th