| Backgrounds and Objective The traditional therapy for malignant obstructive jaundice(MOJ) is surgical treatment of tumor, But most of the patients with MOJ usually can not bear operation because of their poor health, or the tumor can not been completely resected. With the development of interventional radiology, percutaneous transhepatic biliary drainage is gradually becoming an important measure to deal with malignant biliary obstruction just because of its minimal invasion and fine drainage effect and well endurance. MOJ frequently bring on a series of pathophysiological change and cause multiple system injury such as high serum bilirubin,hepatic and renal failure and depression of cellular immune founction. In this subject, the levels of TNF-a and T lymphocyte subsets(TLS) in patients with MOJ pre- and post- biliary drainage was studied, and the relation between TNF-a with hepatic function indexes,TNF-a with cellular immunity in MOJ was analyzed. The purpose is to explore the mechanism which caused the change of the immune function and its effect on recovery in patients with MOJ.Materials and Methods Percutaneous transhepatic cholangiography and drainage (PTCD) was performed in 45 patients with MOJ. According to the difference of therapy,all cases were divided into 3 groups: the external drainage group(n=13), the inner-outer drainage group(n=17),and the internal drainage group(n=15). Hepatic function index,TNF-a level and T lymphocyte phenotypes of 45 patients with MOJ were measured 1 day before and 1 week after biliary drainage and then hepatic functionindex was done again 2 weeks after drainage. The serum TNF-a in 45 cases was tested by means of ELISA. T lymphocyte phenotypes were tested by FCM. A correlative study was done between the related index observed above with linear regression analysis, and a comparison with those of 20 Healthy volunteers was carried out as well.Results 45 patients with MOJ showed a relief of jaundice. The mean serum total bilirubin(TBIL) concentration prior to and after the procedures were (343.54+105.56) u mol/L and (290.56 + 103.46) u mol/L in external drainage group, (321.19 + 110.50) u mol/L and (275.64+103.09) u mol/L in the inner-outer drainage group, (337.97+116.26) and (283.72 + 104.95) u mol/L u mol/L in the internal drainage group. There is no significant difference of the mean serum total bilirubin concentrations between the three groups prior to the procedures (P > 0.05), but the mean serum total bilirubin concentration after the procedures in three groups was significantly lower than that prior to the procedures (P < 0.05).No significant difference was found between the three groups. The serum ALT decreased significantly 1 week after the drainage in all three groups, and the ALT still decreased significantly 2 weeks after the drainage in comparsion with that 1 week after in group2 and 3. The serum TNF-a level and the TLS after the drainage were significantly lower than those before the drainage in the group2 and group3 (P<0.01). No significantly difference in the external drainage group before and after the drainage(P>0.05). The serum TNF-a level had a positive correlation with ALT level(the mean of r respectively is 0.81,0.76,0.91 before the procedures, P<0.01; the mean of r respectively is 0.94,0.59,0.93 after the procedures, P<0.05). Conclusions Cellular immune founction in MOJ was obviously decreased as compared with Healthy volunteers. Internal drainage and a combination of external and internal drainage could effectively improve host cellular immunity. The increased biological activity of serum TNF-a may be an important factor for the worsen hepatic function ,which caused the depression of the cellular immune function in patients withMOJ. PTCD is an effective and important therapeutic method for patients with MOJ,which not only relieve the jaundice but also improve the cellular immune founction.
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