腹腔镜贲门癌手术对贲门癌患者hs—CRP、T淋巴细胞亚群及免疫球蛋白的影响机制研究(1)
[摘要] 目的 研究腹腔镜贲门癌手术对患者hs-CRP、T淋巴细胞亚群及免疫球蛋白的影响。 方法 选择2009年12月～2015年12月我院治疗的贲门癌患者60例，根据手术方式的不同随机分为两组：其中腹腔镜组30例，余30例行开腹手术为对照组，比较两组贲门癌患者手术前后hs-CRP、调节性T细胞及免疫球蛋白水平的变化。 结果 腹腔镜组hs-CRP水平术后3、7 d分别显著低于对照组，腹腔镜组患者术后7 d外周血CD3+、CD4+、CD4+/CD8+活性恢复至接近术前水平(P>0.05)，而对照组仍显著低于腹腔镜组(P<0.05)。对照组术后3、7 d的IgM水平分别显著低于腹腔镜组(P<0.05)。 结论 腹腔镜贲门癌手术对hs-CRP及T淋巴细胞亚群与免疫球蛋白的变化较开腹手术变化小，对机体的免疫抑制轻，能更好地保护患者的免疫功能，且可以减轻术后急性期反应，有效避免术后因免疫导致的感染等并发症的发生，有利于促进患者术后尽快恢复。
[关键词] 腹腔镜手术；贲门癌；hs-CRP；T淋巴细胞亚群；免疫球蛋白
[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-9701(2016)13-0012-04
Influencing mechanism research of laparoscopic cardiac cancer surgery on hs-CRP， T lymphocyte subsets and immune globulin
WANG Zhiyan CHEN Ting WANG Yong WU Biao
Department of Surgery， Yinzhou Second Hospital of Ningbo City， Ningbo 315100， China
[Abstract] Objectives To explore the influence of laparoscopic cardiac cancer surgery on hs-CRP， T lymphocyte subsets and immune globulin of patients. Methods 60 patients with cardiac cancer treated in our hospital from December 2009 to December 2015 were selected and divided according to operation methods into two groups： the laparoscope group (30 patients) and the open surgery group(30 patients). The changes of levels of hs-CRP， regulatory T cell， and immune globulin were compared between two groups. Results The level of hs-CRP was significantly lower in the laparoscope group than in the open surgery group at 3 days and 7 days after operation. In the laparoscope group， the activity of CD3+， CD4+， CD4+/CD8+ in peripheral blood recovered nearly to that before operation at 7 days after operation(P>0.05)， and the control group was significantly lower than that in laparoscope group(P<0.05). The levels of IgM in the control group at 3 days and 7 days after operation were respectively significantly lower than those in the laparoscope group(P<0.05). Conclusion Laparoscopic cardiac cancer surgery leads to slighter changes in hs-CRP， T lymphocyte subsets and immune globulin levels and immunosuppression than open surgery does， thus can protect the immunity function of patients and relieve reactions at acute phase after surgery， effectively avoiding complications such as infection that may be caused by immunosuppression and facilitating rehabilitation of patients after operation.
[Key words] Laparoscopic surgery； Cardiac cancer； Hs-CRP； T lymphocyte subsets； Immune globulin
贲门癌是常见病，传统贲门癌的治疗主要采用经胸或经腹贲门癌根治术，但贲门癌手术解剖结构复杂、解剖层面多、淋巴结转移范围广，加上周围血管丰富，开腹手术难度较大[1]。随着腹腔镜技术的进一步成熟，由于腹腔镜手术对患者身体的损伤小、患者痛苦少且术后恢复快，目前已经成为治疗贲门癌的主要方法。但腹腔镜手术作为一种创伤性手术，可影响机体的免疫功能和炎症因子不同程度的表达，主要表现在超敏C反应蛋白(hs-CRP)、T淋巴细胞亚群及免疫球蛋白等指标的变化。hs-CRP由肝细胞合成，是一种急性反应蛋白，研究发现，血清中hs-CRP水平与手术创伤大小呈正相关[2]。另一方面，机体对肿瘤的免疫应答主要包括细胞免疫和体液免疫，且主要以T细胞参与的细胞免疫为主，CD3+、CD4+、CD4+/CD8+等T细胞亚群可以直接反映肿瘤患者术后的免疫功能；体液免疫通过IgA、IgG、IgM免疫球蛋白发挥抗肿瘤的免疫效应[3]，目前对腹腔镜贲门癌手术在hs-CRP及补体与免疫球蛋白方面研究较少，本研究旨在探讨腹腔镜贲门癌手术对患者hs-CRP、T淋巴细胞亚群及免疫球蛋白的影响机制，现报道如下。, 百拇医药(王志炎 陈婷 王勇 吴彪)
[关键词] 腹腔镜手术；贲门癌；hs-CRP；T淋巴细胞亚群；免疫球蛋白
[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-9701(2016)13-0012-04
Influencing mechanism research of laparoscopic cardiac cancer surgery on hs-CRP， T lymphocyte subsets and immune globulin
WANG Zhiyan CHEN Ting WANG Yong WU Biao
Department of Surgery， Yinzhou Second Hospital of Ningbo City， Ningbo 315100， China
[Abstract] Objectives To explore the influence of laparoscopic cardiac cancer surgery on hs-CRP， T lymphocyte subsets and immune globulin of patients. Methods 60 patients with cardiac cancer treated in our hospital from December 2009 to December 2015 were selected and divided according to operation methods into two groups： the laparoscope group (30 patients) and the open surgery group(30 patients). The changes of levels of hs-CRP， regulatory T cell， and immune globulin were compared between two groups. Results The level of hs-CRP was significantly lower in the laparoscope group than in the open surgery group at 3 days and 7 days after operation. In the laparoscope group， the activity of CD3+， CD4+， CD4+/CD8+ in peripheral blood recovered nearly to that before operation at 7 days after operation(P>0.05)， and the control group was significantly lower than that in laparoscope group(P<0.05). The levels of IgM in the control group at 3 days and 7 days after operation were respectively significantly lower than those in the laparoscope group(P<0.05). Conclusion Laparoscopic cardiac cancer surgery leads to slighter changes in hs-CRP， T lymphocyte subsets and immune globulin levels and immunosuppression than open surgery does， thus can protect the immunity function of patients and relieve reactions at acute phase after surgery， effectively avoiding complications such as infection that may be caused by immunosuppression and facilitating rehabilitation of patients after operation.
[Key words] Laparoscopic surgery； Cardiac cancer； Hs-CRP； T lymphocyte subsets； Immune globulin
贲门癌是常见病，传统贲门癌的治疗主要采用经胸或经腹贲门癌根治术，但贲门癌手术解剖结构复杂、解剖层面多、淋巴结转移范围广，加上周围血管丰富，开腹手术难度较大[1]。随着腹腔镜技术的进一步成熟，由于腹腔镜手术对患者身体的损伤小、患者痛苦少且术后恢复快，目前已经成为治疗贲门癌的主要方法。但腹腔镜手术作为一种创伤性手术，可影响机体的免疫功能和炎症因子不同程度的表达，主要表现在超敏C反应蛋白(hs-CRP)、T淋巴细胞亚群及免疫球蛋白等指标的变化。hs-CRP由肝细胞合成，是一种急性反应蛋白，研究发现，血清中hs-CRP水平与手术创伤大小呈正相关[2]。另一方面，机体对肿瘤的免疫应答主要包括细胞免疫和体液免疫，且主要以T细胞参与的细胞免疫为主，CD3+、CD4+、CD4+/CD8+等T细胞亚群可以直接反映肿瘤患者术后的免疫功能；体液免疫通过IgA、IgG、IgM免疫球蛋白发挥抗肿瘤的免疫效应[3]，目前对腹腔镜贲门癌手术在hs-CRP及补体与免疫球蛋白方面研究较少，本研究旨在探讨腹腔镜贲门癌手术对患者hs-CRP、T淋巴细胞亚群及免疫球蛋白的影响机制，现报道如下。, 百拇医药(王志炎 陈婷 王勇 吴彪)