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目的探讨保脾手术对晚期血吸虫病肝纤维化及相关细胞因子的影响。方法新西兰兔50只随机分为正常对照组(NCG)10只、模型对照组(MCG)12只、全脾切除组(TSG)14只、脾大部切除组(SSG)14只。后3组(MCG、TSG、SSG)先制作血吸虫病肝纤维化模型。感染后15周,NCG组和MCG组行假手术,TSG组行全脾切除术,SSG组行脾大部切除术(保留1/3脾组织)。观察各组家兔感染后8、15、21周血清肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素1β(IL-1β)水平的动态变化和术前、术后6周肝组织转化生长因子β1(TGF-β1)、Ⅰ、Ⅲ型胶原的表达变化。结果感染尾蚴后8周,模型家兔血清TNF-α、IL-6、IL-1β水平均较正常对照组显著升高(P均<0.01);至感染后15周(术前),血清TNF-α、IL-6、IL-1β已显著回落(P均<0.01);术后第6周不同手术方式之间比较,血清TNF-α、IL-6、IL-1β水平差异无统计学意义(P>0.05)。术前模型组家兔肝组织TGF-β1和Ⅰ、Ⅲ型胶原表达显著高于正常对照组(P<0.01);术后6周,不同手术方式之间比较,肝组织TGF-β1和Ⅰ、Ⅲ型胶原表达差异无统计学意义(P>0.05)。结论晚期血吸虫病行保脾手术不会加重肝纤维化,可能与晚期血吸虫病TGF-β1、TNF-α、IL-6、IL-1β水平已显著回落,此时切脾不影响这些细胞因子水平有关。
Objective To investigate the effect of spleen-preserving surgery on advanced liver fibrosis and related cytokines in schistosomiasis. Methods Fifty New Zealand white rabbits were randomly divided into 10 groups: normal control group (NCG), 12 model control group (MCG), 14 splenic resection group (TSG) and 14 splenomegaly group (SSG). The latter three groups (MCG, TSG, SSG) first produced schistosomiasis liver fibrosis model. Fifteen weeks after infection, sham-operation was performed in NCG group and MCG group. Splenectomy was performed in TSG group. Subtotal splenectomy was performed in SSG group (1/3 of spleen tissue was reserved). The changes of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-1β (IL-1β) levels were observed at 8, 15 and 21 weeks after infection in rabbits in each group, , 6 weeks after operation, the expression of TGF-β1, type Ⅰ and type Ⅲ collagen in liver tissue was detected. Results Serum levels of TNF-α, IL-6 and IL-1β were significantly increased in the model rabbits at 8 weeks after infection (P <0.01) There was no significant difference in serum TNF-α, IL-6 and IL-1β levels between the different operation methods at the 6th week after operation (P> 0.05). The expression of TGF-β1 and type Ⅰ and type Ⅲ collagen in hepatic tissues in preoperative model group was significantly higher than that in normal control group (P <0.01). At 6 weeks after operation, the expression of TGF-β1, Type Ⅲ collagen expression was no significant difference (P> 0.05). Conclusions The splenic surgery in advanced schistosomiasis does not aggravate hepatic fibrosis and may be associated with a significant decrease in the levels of TGF-β1, TNF-α, IL-6 and IL-1β in advanced schistosomiasis patients. At this time, splenectomy does not affect the levels of these cytokines related.