老年食管癌患者围术期Ｔ淋巴细胞亚群的变化

目的：观察比较老年组和成年组食管癌患者术中、术后Ｔ淋巴细胞亚群变化的趋势。方法：４４例ＡＳＡⅠ ～Ⅱ级食管癌患者分为两组，其中２２例年龄６５岁以上的为老年组；２２例年龄６０岁以下的为成年组。分别于麻醉前、术毕、术后ｄ_１、术后ｄ_２、术后ｄ_５共５个时间点抽取静脉血；采用流式细胞仪测定各组外周血Ｔ淋巴细胞亚群（ＣＤ３＋、ＣＤ４＋、ＣＤ８＋）。结果：术前老年组与成年组之间患者外周血ＣＤ３＋、ＣＤ４＋、ＣＤ４／ＣＤ８水平之间无显著性差异，与各自的麻醉前值相比较，术毕、术后ｄ１、术后ｄ２，两组患者外周血的ＣＤ３＋、ＣＤ４＋及ＣＤ４／ＣＤ８均明显下降（Ｐ＜０.０１）；术后ｄ５成年组的ＣＤ４／ＣＤ８恢复到麻醉前水平（Ｐ＞０.０５），并明显高于老年组（Ｐ＜０.０５）。结论：全麻开胸术后，食管癌患者均有不同程度细胞免疫抑制现象，老年组Ｔ细胞亚群恢复至正常的时间慢于成年组患者。

The change of T-lymphocyte subsets during the perioperation in the elder patients with esophageal carcinoma

Objective：To observe and compare the trend of T-lymphocyte subsets in the elderly and in the adult esophageal carcinoma patients postoperatively. Methods：Forty-four esophageal carcinoma patients were classified as ASA physical status Ⅰ～Ⅱ. Twenty-two patients aged than 65 years, were grouped as elder patients. The rest twenty-two patients served as adult patient group were younger than 60 years old. Jugular venous blood samples were collected before induction of anesthesia as baseline, after completion of surgery, on postoperative d1 ,d2 and d5. The blood count of CD3 ＋ ,CD4 ＋ , CD8 ＋ T-lymphocyte were measured by flowcytometer. Results：Compared with the baseline level, the blood CD3 ＋ , CD4 ＋ and CD4/CD8 levels were significantly decreased immediately after surgery on postoperative d1 and d2 in two groups（ P 〈 0. 01 ） , which returned to baseline values on the postoperative d5 in two groups （P 〉0. 05）. On postoperative d5 , CD3 ＋ , CD4 ＋ and CD4/CD8 in adult group were significantly higher than those in elderly group （ P 〈 0. 05 ）. Conclusion ： The postoperative immune function in elder patients recovered more slowly than that in adult ones.