| AimAt present,Laparoscopic Pericardial Devascularization Combined with Splenectomy(LSPD)is used by more and more medical centers to treat Portal Hypertension(PHT).Complete laparoscopic pericardial devascularization combined with splenectomy(CLSPD)can reduce trauma and shorten recovery time for patients However,the spleen,as an important immune organ,plays an irreplaceable role in reguiating the immune function of the body.The changes in body's immune environment of PHT patients,and the impact of this change on patients with PHT still need further study.In this paper.we examined the changes of immunity homeostasis by detecting representative immune and liver function indexes,and explored the relationship between immunity homeostasis and liver function,and clarified the immunity of patients after spleen severance.To elucidate the changes of immunity homeostasis and its clinical significance after CLPDS.which can provide evidence-based evidence for clinical individualized treatment of PHTMethodsThe clinical data of 46 patients with portal hypertension admitted to the Department of Hepatobiliary and Pancreatic Surgery of Jiangsu Subei People's Hospital from November 2017 to September 2018 were collected.The changes of pre-and post-operative immune and liver indexes of CLPDS in patients with PHT were compared.All operations were performed by the same team.Observation index:All the research objects was tested for TH1 cell frequency.TH2 cell frequency,TH1/TH2 ratio,CD4 cell frequency,CD8 cell frequency,and CD4/CD8 ratio before.1 week.4 weeks.and 12 weeks after surgery.,IgG,IgA,IgM,C3,C4 and other immune-related indicators,as well as TBIL,DBIL,IBIL.ALT.AST.four liver fibrosis indexes(laminin,type III procollagen,type IV procollagen,hyaluronic acid)Liver-related indicators such as enzymes,and MELD scores were calculated to comprehensively assess liver function After operation,some patients were treated with warfarin for anticoagulant therapy,and the Child-Pugh classification could not be accurately evaluated.Therefore,the Child-Pugh classification was not evaluated after operation.Follow-up:All the patients who underwent the study were followed up for follow-up,followed by portal review and telephone follow-up.The follow-up period was twelve weeksResultsThe TH1/TH2 ratio of the experimental group was 9.77± 3.77,and the TH1/TH2 ratio was 7.88±3.52 at 12 weeks after operation.The direction was shifted to TH2(P<0.05).Cellular immunity:the preoperative serum CD4/CD8 ratio was 2.1 1±1.29 The CD4/CD8 ratios were 1.61±0.7,0.8±0.5 at 4 weeks and 12 weeks after surgery,respectively.Preoperative and postoperative 4 weeks,postoperative 12 weeks the ratio of CD4/CD8 was shifted to CD8(P<0.05).In terms of humoral immunity,the serum IgG level was 13.62±3.3 1 g/L.at 1 week postoperatively was 11.63±2.53 g/L,4 weeks and 12 weeks after sureery were 15.41±4.43 g/L and 1 8.06±3.72 g/L(P<0.05).the preoperative serum C3 level was 0.7±0.22 mg/mL,and the serum C3 levels were 0.81±0.2 mg/mL,0.85±0.25 mg/mL and 0.8±0.15 mg/mL,at 1 week,4 weeks and 12 weeks after surgery(P<0.05).Liver function:CLDPS can improve serum bilirubin level,liver enzyme level,MELD score,type ? procollagen level and type IV collagen level(P<0.05).Correlation analysis showed serum hyaluronidase levels showed a positive correlation with serum CD4 cell frequency(preoperative:r=0.381 P=0.008;postoperative:r=0.320 P=0.009)and CD4/CD8 ratio(preoperative:r=0.489 P<0.001;postoperative:r=0.484 P<0.001),and showed a negative correlation with serum CD8 cell frequency(preoperative:r=-0.446 P=0.002;postoperative:r=-0.427 P<0.001)Conclusion1.Patients with PHT undergoing CLPDS surgery may decrease cellular immune function,enhance humoral immunity,and the balance of TH1/TH2 turn to TH22.Changes in cellular immune function may lead to changes in liver cirrhosis.3.Patients with PHT should be carefully evaluated for their immune status before and after surgery,and individualized follow-up and treatment plans should be developed for the patient's immune status. |
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