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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) ›› 2015, Vol. 09 ›› Issue (02) : 103 -107. doi: 10.3877/cma.j.issn.1674-0793.2015.02.006

论著

梗阻性黄疸患者肠黏膜瘦素及其受体与肠黏膜免疫屏障损害的关系
郭松1, 陈强谱2,†(), 林旭涛2, 张帆2, 张兴元2   
  1. 1.256603 滨州医学院附属医院胃肠外科
    2.256603 滨州医学院附属医院肝胆外科、临床营养中心、山东省临床营养与代谢实验室培育基地
  • 收稿日期:2014-10-14 出版日期:2015-04-01
  • 通信作者: 陈强谱

Association of the change of intestinal mucosal leptin and leptin receptor with the injury of intestinal mucosal immune barrier in patients with obstructive jaundice

Song Guo1, Qiangpu Chen2,†(), Xutao Lin2, Fan Zhang2, Xingyuan Zhang2   

  1. 1.Department of Gastrointestinal Surgery, Clinical Nutrition Center, Clinical Nutrition and Metabolism Laboratory, the Affiliated Hospital of Binzhou Medical College, Binzhou 256603, China
    2.Department of Hepatobiliary Surgery, Clinical Nutrition Center, Clinical Nutrition and Metabolism Laboratory, the Affiliated Hospital of Binzhou Medical College, Binzhou 256603, China
  • Received:2014-10-14 Published:2015-04-01
  • Corresponding author: Qiangpu Chen
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郭松, 陈强谱, 林旭涛, 张帆, 张兴元. 梗阻性黄疸患者肠黏膜瘦素及其受体与肠黏膜免疫屏障损害的关系[J/OL]. 中华普通外科学文献(电子版), 2015, 09(02): 103-107.

Song Guo, Qiangpu Chen, Xutao Lin, Fan Zhang, Xingyuan Zhang. Association of the change of intestinal mucosal leptin and leptin receptor with the injury of intestinal mucosal immune barrier in patients with obstructive jaundice[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(02): 103-107.

目的

研究梗阻性黄疸患者肠黏膜瘦素(Lp)、瘦素受体(Ob-R)表达水平与肠黏膜免疫屏障损害(CD4+、CD8+T 细胞数量)的关系。

方法

收集2012 年3 月至2013 年7 月间因梗阻性黄疸住院手术治疗患者30 例为试验组(OJ 组), 再根据血清总胆红素浓度分为轻度黄疸组(≤171 μmol/L,OJ 1 组, 17 例),中重度黄疸组(＞171 μmol/L,OJ 2 组,13 例);同期非黄疸患者21 例为对照组。 采用免疫组化法检测梗阻性黄疸患者小肠黏膜及正常小肠黏膜中Lp 和Ob-R 表达水平以及CD4+、CD8+T 细胞数量, 分析其相关性。

结果

梗阻性黄疸患者肠黏膜Lp 和Ob-R 表达水平、CD4+、CD8+T 细胞的数量均低于对照组(Lp:OJ 组1.63±1.25,对照组2.48±1.25,P＜0.05;Ob-R:OJ 组2.63±1.27,对照组3.90±1.00,P＜0.05;CD4+:OJ 组17.74±4.33,对照组28.33±4.53,P ＜0.05;CD8+:OJ 组11.61±3.36;对照组15.95±3.69,P＜0.05);肠黏膜Lp 和Ob-R 表达水平与肠黏膜CD4+、CD8+T 细胞的数量呈正相关(P＜0.05)。

结论

梗阻性黄疸患者肠黏膜Lp 和Ob-R 表达减少与肠黏膜CD4+、CD8+T 细胞的数量减少相关,Lp 可能对肠黏膜免疫屏障的稳定起一定作用。

关键词: 梗阻性黄疸, 瘦素, 瘦素受体, CD4+, CD8+

Objective

To study the change of leptin, leptin receptor, CD4+, CD8+ lymphocytes in the mucosa of the small intestine of patients with obstructive jaundice, and to investigate the relationship between leptin and leptin receptor (Ob-R) and intestinal mucosal immune barrier of patients with obstructive jaundice.

Methods

Thirty patients diagnosed as obstructive jaundice in Department of Hepatobiliary Surgery from March 2012 to July 2013 were selected as experimental group. The experimental group were divided into mild jaundice group (≤171 μmol/L, OJ1 group, 17 cases), and moderate to severe jaundice group (＞171 μmol/L, OJ2 group, 13 cases). Twenty-one patients during the same period without obstructive jaundice were selected as negative controls. Immunohistochemistry was performed in detecting the expression of leptin, OB-R and CD4+, CD8+ lymphocytes in all patients.

Results

The expression of leptin,leptin receptor, CD4+ and CD8+ lymphocytes in experimental group were lower than the control group (Lp 1.63±1.25 vs 2.48±1.25; Ob-R 2.63±1.27 vs 3.90±1.00; CD4+ 17.74±4.33 vs 28.33±4.53; CD8+ 11.61±3.36 vs 15.95±3.69; all P ＜0.05). There was negative correlation between bilirubin and leptin, OB-R,CD4+ and CD8+ lymphocytes; there was positive correlation between leptin, OB-R and CD4+ and CD8+lymphocytes.

Conclusions

The expression of leptin, OB-R, CD4+ and CD8+ lymphocytes are declined in intestinal mucosa of patients with obstructive jaundice. Leptin may exert positive effects in intestinal mucosal immune barrier with obstructive jaundice.

Key words: Obstructive jaundice, Leptin, Leptin receptor, CD4+, CD8+
表1 梗阻性黄疸患者与对照组中TBIL、Lp、Ob-R、CD4+、CD8+的水平
组别 例数 TBIL(μmol/L) Lp Ob-R CD4+(个) CD8+(个)
对照组 21 17.48±13.71 2.48±1.25 3.90±1.00 28.33±4.53 15.95±3.69
OJ组 30 189.57±97.39a 1.63±1.25a 2.63±1.27a 17.74±4.33a 11.61±3.36a
OJ1组 17 133.37±23.87 2.12±1.11 3.29±0.77 19.88±3.90 13.82±2.38
OJ2组 13 303.40±116.04b 1.00±1.15b 1.77±1.30b 15.77±2.49b 9.08±2.25b
图1 对照组(A)与OJ 组(B)肠黏膜Lp 表达的变化(IHC ×400)
图2 对照组(A)与OJ 组(B)肠黏膜Ob-R 表达的变化(IHC×400)
图3 对照组(A)与OJ 组(B)肠黏膜CD4+数量的变化(IHC ×400)
图4 对照组(A)与OJ 组(B)肠黏膜CD8+数量的变化(IHC ×400)
表2 肠黏膜Lp、Ob-R 水平与CD4+、CD8+T 细胞数量的相关性分析rs 值
项目 Lp表达水平 Ob-R表达水平
OJ组 OJ1组 OJ2组 OJ组 OJ1组 OJ2组
CD4+T细胞数量 0.655a 0.487a 0.686a 0.655b 0.539b 0.450
CD8+T细胞数量 0.717c 0.708c 0.356 0.687d 0.500d 0.259
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