腹腔镜手术对HIV感染者免疫功能的影响

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(laparoscopic cholecystectomy,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C3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(+)0.05)。CD4/CD8手术前后HIV(+)0.05)。CRPHIV(+)组术前>POD3,7(P<0.05)。CRP HIV(-)组术前

Effects of laparoscopic surgery on immune function of HIV-infected patients

Objective:To evaluate the effects of laparoscopic operations on immune function of HIV-infected patients.Methods:Fourty-two cases of benign gallbladder diseases were divided into two groups:22 HIV(+)cases and 20 HIV(-)cases,and all cases underwent the laparoscopic cholecystectomy(LC).All cases were analyzed for peripheral blood cells and plasma albumin,the subset of T Lymphocyte(CD3,CD4,CD8,their percentages and CD4/CD8)with flow cytometric assessment,IgG,IgM,IgA,C3,C4 and CRP on the day before operation,the third and seventh day after operation.Plasma HIV-RNA was detected in HIV positive cases.Statistical analysis was performed by SPASS 12.0.Results:There were no clinically significant decrease of peripheral blood cells and plasma albumin in HIV(+)group compared with HIV(-)and HIV-RNA measured below 50 copies/ml in all of HIV(+)group.Mean CD4counts in HIV(+)patients were 309.1,260.5,300 cell/ml while 499.3,580,462 in HIV(-)group respectively on POD 1,3,7.There were statistical significant difference between the two groups(P<0.05).In HIV(+)group,CD4 were significantly lower on POD 3 than those on POD 1 and 7(P<0.05).There were also lower expression CD4/CD8 in HIV(+)group(0.47,0.53,0.50)than those in HIV(-)group(0.96,1.04,1.15)(P<0.05).No significant difference of CD4 were seen in the same group of HIV(-)group and CD4/CD8 in the same group of the two in pre-and postoperative time(P>0.05).IgA in HIV(+)group were higher than those in HIV(-)group and There was no clinically significant difference of IgG、IgM,C3,C4 in preoperative and postoperative time between the two groups.Significantly higher CRP of preoperation was seen in HIV(+)group than those of postoperation.Adversely,CRP of preoperation in HIV(-)group were less than that of postoperation.No postoperative complications and mortality occurred in all cases.Conclusions:LC has no clinical effects on humoral immune responses of HIV-infected patients.Although LC has been shown mild immunesuppression temporarily in HIV(+)patients,LC may result in less induced surgical trauma than conventional open surgery without postoperative risk of complications or death.However,perioperative CD4 and HIV-1 RNA may be useful risk indicators for HIV(+)patients.In these cases,CD4 count should be maximized to ≥200 cell/ml so as to minimize postoperative complications and mortality.