妇科恶性肿瘤腹腔镜术建立CO2气腹过程中的腹膜免疫因子变迁机制

目的 探讨妇科恶性肿瘤腹腔镜术建立CO2气腹过程中的腹膜免疫因子变迁机制。方法 选取广州医科大学附属肿瘤医院妇科恶性肿瘤患者64例。根据手术方式将其分为两组,观察组34例,行腹腔镜术;对照组30例,行传统开腹手术。采用流式细胞术测定术前术后外周血CD4＋T淋巴细胞、NK细胞及CD4＋CD25highCD127lowTreg水平;采用ELISA法检测术后腹膜免疫因子IL-6、TNF-β、TNF-α水平。结果 经建立CO2气腹的腹腔镜术后1 d观察组患者外周血CD4＋T淋巴细胞、NK细胞水平显著低于对照组,而CD4＋CD25highCD127lowTreg细胞水平显著高于对照组（P〈0.05）;但术前1 d及术后1周,两组患者的外周血CD4＋T淋巴细胞、NK细胞及CD4＋CD25highCD127lowTreg细胞水平比较差异无统计学意义（P〉0.05）;观察组腹膜免疫因子（IL-6、TNF-α）水平均显著低于对照组,而TNF-β水平显著高于对照组（P〈0.05）;CD4＋CD25highCD127lowTreg水平与恶性肿瘤的临床分期相关,表现为Ⅱ～Ⅲ期患者显著高于Ⅰ期患者（P〈0.05）;经Pearson相关性分析发现：CD4＋CD25highCD127lowTreg与IL-6、TNF-α水平呈负相关（r=-0.741、-0.695,P〈0.05）;CD4＋CD25highCD127lowTreg与TNF-β呈正相关（r=0.694,P〈0.05）。结论 妇科恶性肿瘤腹腔镜术建立CO2气腹过程中可能通过抑制腹膜免疫因子IL-6、TNF-α水平或增加CD4＋CD25highCD127lowTreg细胞水平的方式降低患者的免疫功能,随术后时间的延长患者免疫功能可恢复。

Mechanism of peritoneal immune factors change during establishing CO2 pneumoperitoneum in gynecological malignant tumor laparoscopy

Objective To discuss the mechanism of peritoneal immune factors change during establishing CO2 pneu- moperitoneum in gynecological malignant tumor laparoseopy. Methods 64 patients with malignant gynecological tumor in Cancer Center of Guangzhou Medical University were selected. According to the operation mode all patients were di- vided into two groups, the observation group （n = 34） was treated with laparoseopie surgery, control group （n = 30） was treated with traditional open operation. The levels of preoperative and postoperative peripheral blood CD4 ＋T＇ lympho- eytes, NK cells and CD4＋CD25highCD127lowTreg were detected by flow cytometry. ELISA method was used to detect post- operative peritoneal immune factors IL-6, TNE-β, TNF-α. Results 1 day after establishing CO2 pneumoperitoneum in gynecological malignant tumor laparoscopy, CD4＋T lymphocytes, NK cells of observation group were significantly lower than those of the control group, while the level of CD4＋CD25highCD127lowTreg cells was significantly higher than that of the control group （P 〈 0.05）; but 1 weeks after operation and 1 days before operation, the two groups had no statistically sig- nificant differences in the peripheral blood CD4＋T lymphocyte, NK cells and CD4＋CD25highCD127lowTreg cells level （P 〉 0.05）. In observation group peritoneal immune factors （IL-6, TNF-ct） levels were significantly lower than those in the control group, while the level of TNF-β was significantly higher than that in the control group （P 〈 0.05）. ClinicalCD4＋CD25highCD127lowTreg level was related with clinical staging of malignant tumor, Ⅱ - Ⅲ clinical staging patients were higher than the I clinical staging patients （P 〈 0.05）. Pearson correlation analysis showed that CD4＋CD25highCD127lowTreg was negatively correlated with IL-6, TNF-α （r = -0.741, -0.695, P 〈 0.05）; CD4＋CD25highCD127lowTreg and TNF-β was positively correlated （r = 0.694, P 〈 0.05）. Conclusion Establishing CO2 pneumoperitoneum in