新生儿坏死性小肠结肠炎回肠造口术后细胞和体液免疫水平的改变

摘要

目的 新生儿坏死性小肠结肠炎(neonatal neerotizing enterocolitis,NEC)是一种全身免疫紊乱累及肠道导致回结肠炎症坏死的一种严重疾病,回肠造口术是常有的手术方式,本文拟探讨术后细胞和体液免疫水平的改变.方法 通过流式细胞仪和生化仪检测NEC患儿围手术期总淋巴细胞亚群(total lymphocyte subsets,TBNK)和免疫球蛋白水平,并与其他疾病肠道手术患儿进行对比分析.结果 两组患儿入院时基本情况、手术应激和恢复情况相当,相比对照组,NEC组患儿术前NK细胞数量(266.40±351.80) cells/μl和辅助T细胞/抑制T细胞比例(2.80±1.88)％明显下降(P=0.02,P=0.01),淋巴细胞绝对数(3884.69±3280.17) cells/μl、辅助T细胞绝对数(1805.16±1277.90) cells/μl较高(P=0.05,P=0.05),免疫球蛋白IgG水平(8.39±3.03)g/L明显升高(P=0.01).至术后第三天临床情况稳定后NEC组患儿仍处于免疫亢进状态,B细胞/淋巴细胞比例(16.84±9.62)％有所上升(P=0.03),其分泌的补体C4(0.16±0.05) g/L也明显升高(P=0.03).两组术后未观察到严重并发症以及死亡.结论 NEC患儿术后3d仍处于免疫亢进状态,提示应对这些高危儿的细胞免疫和体液免疫水平进行动态监测,为后续的肠内营养支持、特别是早期肠内营养提供参考,提高治疗效率、改善临床结局.另外,这些免疫成分的变化机制尚待进一步研究.%Objective Neonatal necrotizing enterocolitis (NEC) is a systemic immune disorder of intestines causing inflammatory necrosis.And ileostomy is a common surgical option.The present study was intended to examine the postoperative changes of cellular and humoral immunity.Methods Through flow cytometry and biochemical detection,total lymphocyte subsets (TBNK) and immunoglobulin levels in NEC patients during postoperative periods were compared with children of other diseases undergoing intestinal surgery.Results Two groups were compared with regards to basic profiles,surgical stress and postoperative recovery.As compared to control group,the preoperative number of NK cells (266.40±351.80) cells/μl and T helper cell/T cell ratio (2.80 ± 1.88)％ decreased significantly in NEC group (P =0.02,P =0.01) while absolute lymphocyte count (3884.69 ± 3280.17) cells/μl,helper T cell absolute number (1805.16 ± 1277.90) cells/μl higher (P =0.05,P =0.05) and immunoglobulin IgG (8.39 ± 3.03) g/L significantly increased (P =0.01).Until clinically stable at Day 3 postoperatively,NEC group remained in a state of immune hyperfunction with a higher B cell/lymphocyte ratio of (16.84 ± 9.62) ％ (p =0.03) and a significantly higher secretion of complement C4 of (0.16 ± 0.05) g/L (P =0.03).Neither groups had any occurrence of severe serious complications or death.Conclusions Until Day 3 post-operatively,NEC children remain in an immune hyperfunction condition.Dynamic monitoring of cellular and humoral immunity responses may guide subsequent enteral nutrition supports to provide references for early enteral nutrition,to improve treatment efficiency and to optimize clinical outcomes.The underlying mechanisms of these immune components should be further elucidated.