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目的:观察腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)对不同免疫缺陷程度的人免疫缺陷病毒(human immunodeficiency virus,HIV)感染者细胞免疫功能的影响.方法:62例HIV阳性(HIV+)与同期随机32例HIV阴性(HIV-)共94例需LC患者,检测其术前1 d(D0)、术后第3天(D3)、术后第7天(D7)外周静脉血T淋巴细胞亚群CD4和CD8计数(单位cell/μL).各自计算D3、D7两次CD4计数相对于D0百分比D3/D0(%)、D7/D0(%).并根据术前1 d(D0)CD4计数分层(组),Ⅰ≥500>Ⅱ≥200>Ⅲ≥0.SPSS19.0软件包分析每组内前后差异以及各层组之间差异.结果:在各组内部前后3次检测中,白细胞计数、中性粒细胞率、淋巴细胞率、CD8计数差异无统计学意义(P>0.05),CD4计数各组内部前后3次检测两两对比差异有统计学意义(P<0.001).不同组别之间差异有统计学意义(F=203.80,P<0.001).时间和组别两个因素之间有交互效应(F=8.08,P<0.001).结论:LC手术对以CD4为主的细胞免疫功能有“先抑制后恢复”的影响过程,其影响过程体现出从HIV-Ⅰ组的“V”型到HIV+Ⅲ组的“L”型的渐变规律.HIV感染者免疫缺陷程度越重,其免疫抑制越明显,其免疫恢复也更缓慢.对HIV感染者施行手术需要正确把握手术适应症、重视免疫干预并且进行有针对性的围术期处理.
Objective: To observe the effect of laparoscopic cholecystectomy (LC) on cellular immune function of human immunodeficiency virus (HIV) infected with different immunodeficiency.Methods: 62 cases of HIV positive (HIV + A total of 94 patients with LC were enrolled in this study. A total of 94 patients with LC were enrolled in the study. One week before operation (D0), three days after operation (D3), and 7 days after operation (D7), peripheral blood T lymphocyte subsets Group CD4 and CD8 count (unit cell / μL). Calculate D3, D7 twice CD4 count relative to D0 percentage D3 / D0 (%), D7 / D0 Stratified (group), Ⅰ≥500> Ⅱ≥200> Ⅲ≥0.SPSS19.0 software package analysis before and after each group differences and differences between the various groups.Results: Within the three groups before and after the test, white blood cells There was no significant difference in count, neutrophil rate, lymphocyte rate and CD8 count between the two groups (P> 0.05) The difference between the two groups was statistically significant (F = 203.80, P <0.001). There was interaction between time and group (F = 8.08, P <0.001) .Conclusion: The cellular immune function has the effect of “repressing after first repression”, and its influence process shows the gradual change rule of “L” type from “V” type in HIV-Ⅰ group to “L” type in HIV + The more severe the immunodeficiency is, the more obvious immunosuppression is, and the more slowly the immune recovery is.It is necessary to correctly understand the indications of surgery for HIV-infected patients, pay attention to immune intervention and carry out the targeted perioperative treatment.