| Part OneThe correlation of the complications in partial splenic embolization forhypersplenism with liver cirrhosis due to chronic hepatitis B andintestinal floraObjective To investigate the correlation of the complications in partial splenic embolization for hypersplenism with liver cirrhosis due to chronic hepatitis B and intestinal flora.Methods The objects of study were divided into four groups: normal group, preoperative group, the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis, the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis. The feces samples of all cases were collected for bacterial culture and count. Real-time fluorescent quantitative PCR was used to detect the changes of main bacteria in the intestine(Lactobacillus, Bifidobacterium, Bacteroides, Enterobacter and Enterococcus and Clostridium).Results We mainly cultured 10 kinds of intestinal bacterias, the number of Enterobacter, Enterococcus, Staphylococcus aureus and Saccharomycetes in experimental groups were much more than that in normal group, but the Bacteroides, Bifidobacteria and Lactobacilli significantly decreased. The results of Real-time PCR indicated that the number of Enterobacter, Enterococcus and Clostridium in experimental groups were more than that in normal group, and the number of Bacteroides and Bifidobacteria were fewer than that in normal group, and the Lactobacilli had no differences among these groups. The number of Enterobacter, Enterococcus and Clostridium in the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis was much more than that in preoperative group and the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis, and the number of Bifidobacteria was significantly reduced. The results of Real-time PCR were consistent in bacterial culture.Conclusions Intestinal microecological imbalance exists in the patients with hypersplenism with liver cirrhosis due to chronic hepatitis B treated by partial splenic embolization, especially in patients with postoperative complications and dysbacteriosis is more apparent.Part TwoThe correlation of the complications in partial splenic embolization forhypersplenism with liver cirrhosis due to chronic hepatitis B andinflammatory cytokines and endotoxinObjective To investigate the correlation of the complications in partial splenic embolization for hypersplenism with liver cirrhosis due to chronic hepatitis B and inflammatory cytokines and endotoxin.Methods The objects of study were divided into three groups: normal group, the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis, the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis. The expression of LPS,IL-6,IL-8,TNF-αand s ICAM-1 in the peripheral blood in preoperative and postoperative 7 days and 1 month were detected by ELISA.Results The LPS、IL-6、IL-8、TNF-α and s ICAM-1 in the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis were more than normal, and much higher than that in pre-operation at postoperative 7 days. The LPS、IL-6、IL-8、TNF-α and s ICAM-1 in the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis were also more than normal. Compared to the preoperative level, no differences were found in LPS、IL-6、IL-8 and TNF-αin postoperation except s ICAM-1. The LPS、IL-6、IL-8、TNF-α and s ICAM-1 in the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis were higher than that in the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis at postoperative 7 days,but no differences were found in postoperative 1 month.Conclusions The LPS、IL-6、IL-8、TNF-α and s ICAM-1 in patients with hypersplenism with liver cirrhosis and after partial splenic embolization increased continuously in one week, and they can be used as the reference index of complications or not after partial splenic embolization.Part Three The correlation of the complications in partial splenic embolization for hypersplenism with liver cirrhosis due to chronic hepatitis B and immunefunctionObjective To investigate the correlation of the complications in partial splenic embolization for hypersplenism with liver cirrhosis due to chronic hepatitis B and immune function, and explore the immune regulation possible mechanism when splenic immune function changes in partial splenic embolization for hypersplenism with liver cirrhosis due to chronic hepatitis B.Methods The objects of study were divided into three groups: normal group, the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis, the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis. We Used flow cytometry to detect CD3+, CD4+, CD8+T cells and CD4+CD25+CDl27low/-Treg expression in the peripheral blood in preoperative and postoperative 1 month, 6 months, 1 year and 2 years.Automatic immunity analyzer was used to exam immunoglobulin(Ig A, Ig M and Ig G) content.Results The results of flow cytometry tests showed that CD3+, CD4+, CD8+T cells in the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis were lower than normal at beginning, then gradually returned to normal level, but CD4+ T cells were lower than normal group all the time. Compared with the preoperative, the proportion of CD3+, CD4+, CD8+T cells decreased and then rose to normal level. The CD3+, CD4+, CD8+T cells in the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis were lower than normal at beginning, then gradually returned to normal level. Compared to the preoperative level, the proportion of CD3+, CD4+ T cells decreased and then rose to normal level, while CD8+T cells had no statistical difference. The CD3+, CD4+, CD8+T cells in the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis were lower than that in the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis in early period of postoperation, but no differences were found in later period. The CD4+CD25+CDl27low/-Treg in postoperative 1 month and 6 months were much higher than that in normal or pre-operation, and then gradually returned to normal level. The CD4+CD25+CDl27low/-Treg in the group with complications in partial splenic embolization for hypersplenism with liver cirrhosis were higher than that in the group with no complications in partial splenic embolization for hypersplenism with liver cirrhosis in postoperative 1 month and 6 months, and no differences were found in later period. The content of Ig A, Ig G and Ig M had no significant differences among these groups in different times.Conclusions The partial splenic embolization for hypersplenism with liver cirrhosis due to chronic hepatitis B only has short-term impact on the body’s immune function, especially in patients with complications in the early stage, but the immune function of patients will gradually return to normal in later period. In order to reduce complications of partial splenic embolization for hypersplenism with liver cirrhosis due to chronic hepatitis B, we should pay more attention to prevent infection and improve the body immunity in early period of postoperation. |
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