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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2010, Vol. 04 ›› Issue (04) : 370 -374. doi: 10.3877/cma.j.issn.1674-0793.2010.04.019

所属专题： 文献；

论著

免疫性血小板减少性紫癜脾切除血液学疗效与脾脏细胞免疫异常的关系
纪壮奇1, 郑朝旭1,†(), 郑冬2   
  1. 1. 510080　广州，中山大学附属第一医院微创外科
    2. 510080　广州，中山大学附属第一医院血液内科
  • 收稿日期:2010-03-13 出版日期:2010-08-01
  • 通信作者: 郑朝旭
  • 基金资助:
    广东省科技计划项目资助(2008B080703033); 广东省自然科学基金项目(9151008901000061)

Relationship between the hematological outcomes of splenectomy and the abnormal cellular immunity of spleen in immune thrombocytopenic purpura

Zhuang-qi JI1, Chao-xu ZHENG1,†(), Dong ZHENG2   

  1. 1. Department of Minimal Invasive Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2010-03-13 Published:2010-08-01
  • Corresponding author: Chao-xu ZHENG
  • About author:
    Corresponding author: ZHENG Chao-xu, Email:
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纪壮奇, 郑朝旭, 郑冬. 免疫性血小板减少性紫癜脾切除血液学疗效与脾脏细胞免疫异常的关系[J]. 中华普通外科学文献(电子版), 2010, 04(04): 370-374.

Zhuang-qi JI, Chao-xu ZHENG, Dong ZHENG. Relationship between the hematological outcomes of splenectomy and the abnormal cellular immunity of spleen in immune thrombocytopenic purpura[J]. Chinese Archives of General Surgery(Electronic Edition), 2010, 04(04): 370-374.

目的

探讨免疫性血小板减少性紫癜（ITP）脾切除血液学疗效与脾脏细胞免疫的关系。

方法

应用免疫组织化学技术，采用抗人CD3、CD4、CD8单克隆抗体和抗人S100多克隆抗体，分别检测33例脾切除有效（A组）和14例脾切除无效（B组）的ITP患者的脾脏组织标本CD3+细胞、CD4+细胞、CD8+细胞和S100+细胞的表达情况，对照组为12例因外伤性脾破裂行脾切除术的脾脏组织标本（C组）。显微镜下观察脾脏组织动脉周围淋巴鞘（PALS）中染色阳性细胞的百分数，并计算CD4+/CD8+比值。分析3组CD3+、CD4+、CD8+、S100+细胞百分数和CD4+/CD8+细胞比值的差异。

结果

3组PALS中CD3+、CD4+细胞百分数差异均无统计学意义；A组CD8+细胞百分数高于B组（P=0.001）和C组（P<0.01），而C组PALS中CD4+/CD8+比值分别高于A组（P=0.001）和B组（P=0.001）；A组PALS中S100+细胞百分数高于B组（P=0.015）。

结论

ITP患者脾脏细胞免疫存在异常。脾切除血液学疗效与脾脏细胞免疫异常有密切关系。

关键词: 脾切除术, 免疫性血小板减少性紫癜, 细胞免疫
Objective

To investigate the relationship between the hematological outcomes of splenectomy and the abnormal cellular immunity of the spleen in patients with immune thrombocytopenic purpura (ITP).

Methods

With the monoclonal antibody of the anti-human CD3, CD4, CD8 and the polyclonal antibody of the anti-human S100, the expression of the CD3+, CD4+, CD8+ and S100+cell in the specimens of the spleen tissue were detected by the immuohistochemistry method from 33 ITP patients who had response to splenectomy (group A) and 14 cases who had no response to splenectomy (group B). The specimens of the spleen tissue of 12 cases who underwent emergency splenectomy for traumatic rupture of spleen was served as the control group (group C). The percentages of the positive staining cells around the periarterial lymphatic sheath(PALS) of the spleen were counted under the microscope. The ratio of the percentage of CD4+ cell and CD8+ cell was calculated. The differences in the percentages of CD3, CD4, CD8 and S100 positive staining cells, as well as CD4+/CD8+ ratio, were analyzed among the three groups.

Results

No significant difference of the percentage of CD3+ cell and CD4+ cell was found among the three groups. The percentage of the CD8+ cell in the group A was significantly higher than that in the group B(P=0.001) and group C(P<0.01). And CD4+/CD8+ ratio in the group C was also higher than that in the group A (P=0.001) and group B(P=0.01). There was significant difference in the percentages of the S100+ cell between group A and the group B(P=0.015).

Conclusions

Abnormal cellular immunity of spleen is found in patients with ITP. There is close relationship between the hematological outcomes of splenectomy and the abnormal cellular immunity of the spleen.

Key words: Splenectomy, Immune thrombocytopenic purpura, Cellular immune
表1 3组脾切除术患者的一般临床资料对比
组别 例数 年龄(岁) 男/女(例) 病程(月) 随访时间(月)
A组 33 32.73±18.15 8/25 51.67±63.5 25.33±9.09
B组 14 37.57±19.15 6/8 19.36±28.73 26.43±7.96
C组 12 35.37±16.74 4/8 ? ?
χ2、Z或t值 ? -0.805 0.860 -1.798 -0.641
P值 ? 0.429 0.354 0.072 0.641
图1 脾脏动脉周围淋巴鞘组织结构（HE ×200）
图2 ITP患者脾脏动脉周围淋巴鞘（PALS）染色结果（LDP免疫组织化学×200）
表2 3组PALS中CD3+、CD4+、CD8+和S100+细胞百分数及CD4+/CD8+比值的比较（±s，%)
组别 CD3+ CD4+ CD8+ S100+ CD4+/CD8+
A组 52.89±18.71 38.61±24.51 50.19±17.02 2.35±1.06 0.82±0.54
B组 44.63±26.05 39.47±24.97 31.33±20.23 1.72±0.53 1.21±1.18
C组 43.58±9.85 46.66±21.92 28.70±22.19 1.91±0.78 6.27±4.64
χ2或F值 3.715 0.454 12.330 3.776 22.629
P值 0.156 0.638 0.000 0.029 0.000
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