Comparison of effects on immune function of patients with portal hypertension and hypersplenism between total splenectomy and partial splenectomy

doi:10.3877/cma.j.issn.2095-3232.2017.03.015

Abstract

Abstract:

Objective

To compare the effects on the immune function of patients with liver cirrhosis complicated with portal hypertension and hypersplenism between total splenectomy and partial splenectomy.

Methods

Clinical data of 142 patients with liver cirrhosis complicated with portal hypertension and hypersplenism who were admitted to the Second People's Hospital of Fuyang between September 2012 and October 2015 were retrospectively analyzed. Among them, 96 cases were males and 46 females, aged 35-68 years old with a median age of 53 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. According to the surgical procedures, the patients were divided the pericardial devascularization + total splenectomy group (total splenectomy group, n=85) and pericardial devascularization + partial splenectomy group (partial splenectomy group, n=57). The perioperative indexes between two groups were compared using t test. The incidence of postoperative complications was compared using Chi-square test.

Results

The IL-1, IL-2, IL-6, TGF-β and TNF-α level at postoperative 2 months in the total splenectomy group was respectively (37.3±2.5), (35.5±1.0), (47.7±2.6), (54.6±1.2) and (25.3±1.1) μg/L, significantly lower than (45.2±0.7), (47.7±2.3), (57.9±5.6), (67.6±1.2) and (31.5±1.6) μg/L in the partial splenectomy group, whereas the IgM level was (2.15±0.04) g/L in the total splenectomy group, significantly higher than (1.86±0.03) g/L in the partial splenectomy group (t=-7.65, -7.63, -7.78, -10.12, -8.34, 3.55; P<0.05). The incidence of upper gastrointestinal and intraperitoneal hemorrhage in the partial splenectomy group was 25% (14/57), significantly higher than 8% (7/85) in the total splenectomy group (χ²=7.541, P<0.05).

Conclusions

For the patients with liver cirrhosis complicated with portal hypertension and hypersplenism, the immune function of the patients with total splenectomy may recover faster than the patients with partial splenectomy, and the techniques of total splenectomy are safer and more mature and efficacious.

Key words: Hypertension, portal, Hypersplenism, Splenectomy, Partial splenectomy, Immunologic function

Yongjun Wang, Dayong Luo, Heng Li, Wei Zhang, Yiyu Qin, Zhimei Luo. Comparison of effects on immune function of patients with portal hypertension and hypersplenism between total splenectomy and partial splenectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(03): 216-221.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2017.03.015

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2017/V06/I03/216

Figures/Tables 7

References 21

[1]	Liberal R, Grant CR. Cirrhosis and autoimmune liver disease: current understanding[J]. World J Hepatol, 2016, 8(28):1157-1168.
[2]	Licinio R, Losurdo G, Carparelli S, et al. Helicobacter pylori, liver cirrhosis, and portal hypertension: an updated appraisal[J]. Immunopharmacol Immunotoxicol, 2016, 38(6): 408-413.
[3]	Watson GA, Abu-Shanab A, O'Donohoe RL, et al. Enteroscopic management of ectopic varices in a patient with liver cirrhosis and portal hypertension[J]. Case Reports Hepatol, 2016: 2018642.
[4]	Ferrarese A, Zanetto A, Germani G, et al. Rethinking the role of non-selective beta blockers in patients with cirrhosis and portal hypertension[J]. World J Hepatol, 2016, 8(24):1012-1018.
[5]	Wang DQ, Carey MC. Susceptibility to murine cholesterol gallstone formation is not affected by partial disruption of the HDL receptor SR-BI[J]. Biochim Biophys Acta, 2002, 1583(2):141-150.
[6]	Rockey DC. Liver fibrosis reversion after suppression of hepatitis B virus[J]. Clin Liver Dis, 2016, 20(4):667-679.
[7]	吴钦梅，尤红．中国乙型病毒性肝炎肝硬化研究现状[J]．中国病毒病杂志，2014(1): 7-10.
[8]	赵治凤，樊晋宇，张光谋．1400例肝硬化患者流行病学分析[J]．中国卫生检验杂志，2016(3):414-415.
[9]	Gemery JM, Forauer AR, Silas AM, et al. Hypersplenism in liver disease and SLE revisited: current evidence supports an active rather than passive process[J]. BMC Hematol, 2016(16):3.
[10]	Endo Y, Ohta M, Shibata K, et al. Splenectomy for hypersplenism caused by adult T-cell leukemia: report of a case[J]. Surg Today, 2008, 38(12):1148-1151.
[11]	Poddar U, Shava U, Yachha SK, et al.β-Blocker therapy ameliorates hypersplenism due to portal hypertension in children[J]. Hepatol Int, 2015, 9(3): 447-453.
[12]	Hu Q, Takeishi K, Yamashita Y, et al. Splenectomy followed by hepatectomy for hepatocellular carcinoma with hypersplenism and portal hypertension caused by macroglobulinemia[J]. Anticancer Res, 2015, 35(7): 4077-4081.
[13]	Nair H, Berzigotti A, Bosch J. Emerging therapies for portal hypertension in cirrhosis[J]. Expert Opin Emerg Drugs, 2016, 21(2):167-181.
[14]	李展翼，刘莹，刘宇，等．脾切除加贲门周围血管离断术对肝硬化合并脾功能亢进患者肝功能的影响[J/CD]．中华肝脏外科手术学电子杂志，2014, 3(4): 235-237.
[15]	纪泛扑，黄娜，张澍，等．脾切除对丙型病毒性肝炎后肝硬化门静脉高压症患者细胞免疫功能的影响[J/CD]．中华肝脏外科手术学电子杂志，2015, 4(4):232-236.
[16]	Prystupa A, Kiciński P, Sak J, et al. Proinflammatory cytokines (IL-1α, IL-6) and hepatocyte growth factor in patients with alcoholic liver cirrhosis[J]. Gastroenterol Res Pract, 2015:532615.
[17]	Ataseven H, Bahcecioglu IH, Kuzu N, et al. The levels of ghrelin, leptin, TNF-alpha, and IL-6 in liver cirrhosis and hepatocellular carcinoma due to HBV and HDV infection[J]. Mediators Inflamm, 2006(4):78380.
[18]	Walusimbi MS, Dominguez KM, Sands JM, et al. Circulating cellular and humoral elements of immune function following splenic arterial embolisation or splenectomy in trauma patients[J]. Injury, 2012, 43(2):180-183.
[19]	Guo Y, Wu CZ, Liao Y, et al. The expression and significance of CD4⁺CD25⁺ CD127low/- regulatory T cells and Foxp3 in patients with portal hypertension and hypersplenism[J]. Hepatogastroenterology,2013, 60(123): 581-584.
[20]	Rezende-Neto JB, Petroianu A, Santana SK. Subtotal splenectomy and central splenorenal shunt for treatment of bleeding from Roux en Y jejunal loop varices secondary to portal hypertension[J]. Dig Dis Sci, 2008, 53(2): 539-543.
[21]	Guan YS, Hu Y. Clinical application of partial splenic embolization[J]. ScientificWorldJournal, 2014: 961345.

组别	例数	性别（男/女）	年龄（岁，±s）	病毒性肝炎（例）		肝功能Child-Pugh分级（例）
组别	例数	性别（男/女）	年龄（岁，±s）	乙肝	丙肝	A级	B级	C级
全脾切除术组	85	58/27	51±3	50	15	34	43	8
部分脾切除术组	57	38/19	53±4	30	10	23	30	4
检验值	?	χ²=0.038	t=-16.30	χ²=0.050		χ²=0.260
P值	?	>0.05	>0.05	>0.05		>0.05

组别	例数	性别（男/女）	年龄（岁，±s）	病毒性肝炎（例）		肝功能Child-Pugh分级（例）
组别	例数	性别（男/女）	年龄（岁，±s）	乙肝	丙肝	A级	B级	C级
全脾切除术组	85	58/27	51±3	50	15	34	43	8
部分脾切除术组	57	38/19	53±4	30	10	23	30	4
检验值	?	χ²=0.038	t=-16.30	χ²=0.050		χ²=0.260
P值	?	>0.05	>0.05	>0.05		>0.05

组别	例数	WBC(×10⁹/L)			RBC(×10¹²/L)
组别	例数	术前	术后2周	术后2个月	术前	术后2周	术后2个月
全脾切除术组	85	3.19±0.09	15.35±0.87	8.78±0.57	3.55±0.24	3.68±0.45	3.91±0.21
部分脾切除术组	57	2.92±0.11	14.73±0.68	7.16±0.15	3.45±0.06	3.56±0.04	3.77±0.12
t	?	1.96	0.30	1.20	0.14	0.90	0.77
P	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	Hb(g/L)			Plt(×10⁹/L)
组别	例数	术前	术后2周	术后2个月	术前	术后2周	术后2个月
全脾切除术组	85	110±4	116±6	122±3	55.3±2.6	119.5±6.1	158.2±7.7
部分脾切除术组	57	112±4	117±4	121±3	52.6±1.8	118.6±5.9	124.6±4.8
t	?	-0.14	-0.11	0.13	0.45	0.76	4.43
P	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	WBC(×10⁹/L)			RBC(×10¹²/L)
组别	例数	术前	术后2周	术后2个月	术前	术后2周	术后2个月
全脾切除术组	85	3.19±0.09	15.35±0.87	8.78±0.57	3.55±0.24	3.68±0.45	3.91±0.21
部分脾切除术组	57	2.92±0.11	14.73±0.68	7.16±0.15	3.45±0.06	3.56±0.04	3.77±0.12
t	?	1.96	0.30	1.20	0.14	0.90	0.77
P	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	Hb(g/L)			Plt(×10⁹/L)
组别	例数	术前	术后2周	术后2个月	术前	术后2周	术后2个月
全脾切除术组	85	110±4	116±6	122±3	55.3±2.6	119.5±6.1	158.2±7.7
部分脾切除术组	57	112±4	117±4	121±3	52.6±1.8	118.6±5.9	124.6±4.8
t	?	-0.14	-0.11	0.13	0.45	0.76	4.43
P	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	ALB(g/L)			ALT(U/L)
组别	例数	术前	术后2周	术后2个月	术前	术后2周	术后2个月
全脾切除术组	85	37.3±0.9	39.2±0.9	41.5±0.6	59.4±2.3	42.3±1. 6	35.5±1.0
部分脾切除术组	57	37.9±0.8	39.6±1.1	41.9±1.3	63.2±2.9	46.1±2.3	37.7±2.3
t	?	-0.76	-0.89	-0.82	-1.33	-3.27	-1.15
P	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	例数	AST(U/L)			TB(μmol/L)
组别	例数	术前	术后2周	术后2个月	术前	术后2周	术后2个月
全脾切除术组	85	58.4±4.1	43.8±3.3	36.2±1.4	42.1±1.6	35.5±1.0	18.4±0.6
部分脾切除术组	57	60.4±1.8	45.7±1.1	37.9±2.1	46.7±1.2	38.2±1.2	17.6±0.4
t	?	-2.37	-1.59	-0.63	-2.10	-1.40	0.14
P	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

Please choose a citation manager

Content to export