Effect Of Splenectomy And Devascularization On Immune Function And Liver Fibrosis In Patients With Liver Cirrhosis Portal Hypertension

Objective: To observe the effect of splenectomy on immune function and hepatic fibrosis in patients with liver cirrhosis and portal hypertension(PHT),and to provide evidence-based evidence for individualized treatment of PHT and prevention of postoperative immune-related complications.Methods: The clinical data of 30 patients with PHT who underwent surgical treatment in Hepatobiliary Pancreatic Splenic Surgery,Enshi Central Hospital Affiliated to Hubei University for Nationalities from September 2018 to December 2019 were collected.CD4 + cell frequency,CD8 + cell frequency,CD4 + / CD8 + ratio,IgG,IgA,IgM,C3,C4 and other immune related indexes were collected 1 day before operation,1 week after operation,1 month after operation and 3 months after operation.Laminin(LN),type III procollagen peptide(PIIINP),type IV collagen(C-IV),hyaluronidase(HA),liver stiffness measurement(LSM)and other liver fibrosis related indicators;WBC,PLT,Hb,TBIL,DBIL,IBIL,ALT,AST and other blood routine and liver function indexes.Statistical methods were used to compare the changes of the above indicators before and after surgery.Results:(1)The frequency of CD4 + cells and CD4 + / CD8+ ratio in peripheral blood of patients with PHT at 1 month and 3 months after splenectomy were slightly lower than those at 1 day before operation,and the difference was not statistically significant(P > 0.05).The frequency of CD8 + cells in peripheral blood of PHT patients at 1 month and 3 months after splenectomy was slightly higher than that at 1 day before operation,and the difference was not statistically significant(P > 0.05).The levels of serum C3 and IgG in patients with PHT at 1 week,1 month and 3 months after splenectomy were significantly higher than those at 1 day before surgery(P < 0.05).(2)The serum PIIINP and LN levels of PHT patients at 1 week,1 month and 3 months after splenectomy were significantly lower than those at 1 day before surgery,and the difference was statistically significant(P < 0.05).The levels of LSM and serum C-IV in patients with PHT at 1month and 3 months after splenectomy were significantly lower than those at 1 day before surgery(P < 0.05).(3)The levels of WBC,PLT and Hb in peripheral blood of PHT patients at 1 week,1 month and 3 months after splenectomy were significantly higher than those at 1 day before operation,and the difference was statistically significant(P < 0.05).(4)The serum TBIL and IBIL levels of PHT patients at 1 week,1 month and 3 months after splenectomy were significantly lower than those at 1 day before surgery,and the difference was statistically significant(P <0.05).Conclusions:(1)Splenectomy did not significantly improve the cellular immune function and humoral immune function in patients with PHT.(2)Splenectomy can improve the liver function of PHT patients and delay the progress of liver fibrosis.(3)Splenectomy can improve the peripheral blood WBC,PLT and Hb levels of PHT patients.