腹腔镜手术对HIV感染者免疫功能的影响.doc

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1、腹腔镜手术对HIV感染者免疫功能的影响【摘要】　　目的：检测HIV（+）者腹腔镜手术前后主要细胞和体液免疫指标的变化并与HIV（）者对照，探讨微创手术对HIV感染者主要免疫功能的影响。方法：将42例胆囊疾病患者分为２组：观察组（HIV+）22例，对照组（HIV）20例。用同样方法施行腹腔镜胆囊切除术（laparoscopiccholecystectomy,LC）。于术前1d，术后3、7d（POD３，7）检测血常规、白蛋白，CD３、CD4、CD8及其百分比和CD4/CD8；IgG、IgM、IgA，补体C

2、3和C4，CRP。HIV（+）者检测HIVRNA。常规统计学方法处理所得数据。结果：白细胞总数HIV（）组>HIV（+）组(POD３，7)（P<0.05）。淋巴和中性粒细胞无显著变化（P>0.05）。白蛋白２组手术前后>35g/L。IgA手术前后HIV（+）>HIV（）(P<0.05)。IgG、IgGM、C3和C42组手术前后均无显著变化，均在正常范围。CD4HIV（+）者术前1天至术后1月<50copy/ml。组间比较：CD４手术前后HIV（+）<H

3、IV（）（P<0.05）。HIV（+）组内CD4(POD3)0.05）。CD4/CD8手术前后HIV(+)0.05）。CRＰHIV（+）组术前>POD３，7(P<0.05)。CRPHIV（）组术前【关键词】HIV感染　腹腔镜术　免疫功能　　EffectsoflaparoscopicsurgeryonimmunefunctionofHIVinfectedpatients　　【Abstract】Ｏbjective:Toevaluatetheeffectsoflaparoscopicop

4、erationsonimmunefunctionofHIVinfectedpatients.Methods:Fourtytwocasesofbenigngallbladderdiseasesweredividedintotwogroups:22HIV(+)casesand20HIV()cases,andallcasesunderwentthelaparoscopiccholecystectomy(LC).Allcaseswereanalyzedforperipheralbloodcellsandpl

5、asmaalbumin,thesubsetofTLymphocyte(CD３,CD4,CD8,theirpercentagesandCD4/CD8)withflowcytometricassessment,IgG,IgM,IgA,C3,C4andCRPonthedaybeforeoperation,thethirdandseventhdayafteroperation.PlasmaHIVRNAwasdetectedinHIVpositivecases.Statisticalanalysiswasperf

6、ormedbySPASS12.0.Results:TherewerenoclinicallysignificantdecreaseofperipheralbloodcellsandplasmaalbumininHIV(+)groupcomparedwithHIV()andHIVRNAmeasuredbelow50copies/mlinallofHIV(+)group.MeanCD4countsinHIV(+)patientswere309.1,260.5,300cell/mlwhile499.3,58

7、0,462inHIV()grouprespectivelyonPOD1,3,7.Therewerestatisticalsignificantdifferencebetweenthetwogroups(P<0.05).InHIV(+)group,CD4weresignificantlyloweronPOD3thanthoseonPOD1and7(P<0.05).TherewerealsolowerexpressionCD4/CD8inHIV(+)group(0.47,0.53,0.50)th

8、anthosein5HIV()group(0.96,1.04,1.15)(P<0.05).NosignificantdifferenceofCD4wereseeninthesamegroupofHIV()groupandCD4/CD8inthesamegroupofthetwoinpreandpostoperativetime(P>0.05).IgAinHIV(+)groupwerehigherthantho