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

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。

Influence of spleen preservation on hepatic fibrosis and relevant cytokine in rabbits with advanced schistosomiasis

Objective To investigate the effects of spleen preservation on hepatic fibrosis and relevant cytokine in rabbits with advanced schistosomiasis. Methods After hepatic cirrhosis was induced by infecting Schistosoma japonicum cercariae in rabbits, total splenectomy (TSG), subtotal splenectomy (SSG) or sham operation (model control group, MCG) were performed respectively on these rabbits. Meanwhile,a normal control group (NCG) was established. The serum levels of tumor necrosis factor alpha (TNF-α) , interleukin-6 (IL-6) and interleukin-1 beta (IL-lβ) were detected respectively by radioimmunoassay(RIA) at the 8th, 15th and 21st week post-infection. The expressions of transforming growth factor betal (TGF-β1), type Ⅰ and type Ⅲ collagen in liver tissues were determined by immunohistochemistry before and after the operations. Results Compared with NCG, the serum levels of TNF-α, IL-6 and IL-1β of MCG rabbits increased significantly at the 8th week post-infection (P <0.01). However, the levels of them decreased to a lower level at the 15th week. At the 6th week after operation,no significant difference was found among the three model groups ( MCG, TSG, SSG) (P > 0.05). The expressions of TGF-β1, type Ⅰ and type Ⅲ collagen in liver tissue of MCG rabbits were significantly higher than those of NCG rabbits before the operation (P < 0. 01). No significant difference was found among the three model groups at the 6th week after the operation ( P > 0.05). Conclusion The residual splenic tissue after subtotal splenectomy does not aggravate the hepatic fibrosis at advanced schistosomiasis. The mechanism may be that the relevant cytokines of hepatic fibrosis (TGF-β1, TNF-a, IL-6, IL-1β) decreased to a lower level at this time,and splenectomy does not influence the levels of them.