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目的研究经内镜置支架内引流对晚期恶性梗阻性黄疸体液免疫、T淋巴细胞亚群及IL-2,IL-6,sIL-2R和TNF的影响。方法选择临床上恶性梗阻性黄疸经十二指肠镜置支架内引流患者共18例为A组,设10例健康老年人为B组,A组分别于术前1 d、术后3,7和10 d及B组采集晨起空腹外周静脉血测定血清IgA,IgG和IgM的浓度、T细胞亚群CD3+,CD4+,CD8+和SIL-2R,IL-6,IL-2,TNF的浓度。结果A组与术前1 d相比术后3 d IgA,IgG,IgM,TNF,SIL-2R下降,CD4+,CD8+,CD4+/CD8+回升,术后7 d IgG,IL-6,SIL-2R,TNF进一步下降(P<0.01);术后7 d CD3+、CD4+、CD8+、CD4+/CD8+、IL-2进一步回升,与术前相比意义显著,术后10 d CD4+/CD8+升高明显;IgG和SIL-2R进一步下降;术后第10天除免疫球蛋白外与B组相比差别显著。结论术后7 d免疫功能得到明显提高,术后10 d各免疫指标进一步恢复。经内镜内引流术后10 d仍不能达到正常水平,可能与肿瘤的继续作用有关,因此,应加用免疫调节剂或中药进一步增强免疫功能。
Objective To investigate the effects of endoscopic drainage with stent implantation on the humoral immunity, T lymphocyte subsets, IL-2, IL-6, sIL-2R and TNF in patients with advanced malignant obstructive jaundice. Methods A total of 18 patients with malignant obstructive jaundice with duodenal endoscopic drainage were enrolled as group A, 10 healthy controls as group B, group A as control group The concentrations of serum IgA, IgG and IgM, T cell subsets CD3 +, CD4 +, CD8 + and SIL-2R, IL-6, IL-2 and TNF were measured by fasting peripheral venous blood samples at 10 d and group B respectively. Results In group A, the levels of IgA, IgG, IgM, TNF and SIL-2R decreased, CD4 +, CD8 + and CD4 + / CD8 + (P <0.01). The levels of CD3 +, CD4 +, CD8 +, CD4 + / CD8 + and IL-2 increased further on day 7 postoperatively, SIL-2R decreased further. On the 10th postoperative day, the difference between immunoglobulin and B group was significant. Conclusion The immune function was significantly improved on the 7th day after operation, and the immune indexes were further recovered on the 10th day after operation. After endoscopic drainage 10 days still can not reach the normal level may be related to the continued role of the tumor, therefore, should be added with immune modulators or herbs to further enhance the immune function.