超滤浓缩回输对肝硬化腹水患者自然杀伤T细胞及RAAS系统的影响

摘要

目的 观察超滤浓缩回输对肝硬化腹水患者自然杀伤T细胞(NKT)及RAAS系统的影响.方法 将90例肝硬化腹水患者随机分为观察组(n=60)及对照组(n=30),分别给予腹水超滤浓缩回输治疗及常规治疗；比较治疗前后外周血及腹水内NKT细胞及其胞内细胞因子IL-4及IFN-γ含量变化,比较血浆肾素、血管紧张素Ⅱ及醛固酮的变化.结果 治疗前两组患者外周血及腹水NKT、IL-4及IFN-γ 均不存在组间差异,治疗后两组患者上述6项指标均较治疗前上升,且治疗后观察组外周血及腹水的NKT及IFN-γ百分含量均显著高于对照组(P＜0.05),但IL-4无组间差异.治疗前两组患者的肾素、血管紧张素Ⅱ及醛固酮均不存在组间差异.治疗后以上三项指标均呈不同程度下降,且观察组这三项指标较治疗前显著下降(P＜0.05),但对照组仅血管紧张素Ⅱ及醛固酮较治疗前显著下降(P＜0.05),而肾素无统计学差异.治疗后,观察组肾素、血管紧张素Ⅱ及醛固酮水平均明显低于对照组(P值分别为0.041、0.023及0.035).相关性分析显示NKT及IFN-γ两者,与肾素、血管紧张素Ⅱ及醛固酮三者当中的任意一者均呈负相关性,(r均＞0.6,P＜0.05).但IL-4与RAAS指标无相关性(P＞0.05).结论 腹水超滤浓缩回输可增强NKT细胞及IFN-γ的活性,抑制RAAS激素活性,提示该方法具有免疫调节作用,是治疗肝硬化腹水患者的—个新机制.%Objective To observe the impact of ascites reinfusion on natural killer T cells (NKT) and the RAAS system. Methods Ninety patients with cirrhosis were randomly divided into reinfusion group (n = 60) and control group (n = 30), and were given ascites reinfusion therapy and conventional treatment, respectively; changes of NKT cells in peripheral blood and ascites as well as its intracellular cytokines IL-4 and IFN-γ levels before and after treatment were compared, and the serum rerun, angiotensin Ⅱ and aldosterone changes were also observed. Results Before treatment, NKT, IL-4 and IFN--γ in peripheral blood and ascites were not different between the two groups. After treatment, NKT and IFN-γ were significantly higher in reinfusion group than in control group (P < 0.05), but IL-4 levels had no difference between the two groups. Before treatment, there were no differences in serum renin, angiotensin II and aldosterone levels between the two groups. After treatment, the three indicators showed different degrees of decline, and more significant in the reinfusion group (P < 0.05), but there was no significant change in renin levels in the control group. However, renin, angiotensin II and aldosterone in ascites were significantly lower in the reinfusion group than that in the control group (P -0.041,0.023 and 0.035). NKT and IFN-γ had a negative correlation with renin, angiotensin Ⅱ, and aldosterone levels. However, IL-4 and RAAS index did not show any correlation (P > 0.05). Conclusion Ascites-concen-tration reinfusion can enhance the activity of NKT cells and IFN-γ with the inhibition of the RAAS activity, suggesting it is a new mmunomodulatory mechanism for the treatment of patients with cirrhosis.