【摘要】 目的 觀察手術前后乳腺癌患者體內輔助性T淋巴細胞（helper T lymphocyte，Th） 1、2型細胞因子的表達及意義。 方法 2009年11月－2010年12月，采用酶聯免疫吸附試驗檢測40例乳腺癌患者（乳腺癌組）手術前、后和15例健康婦女（正常對照組）外周血單個核細胞培養上清液中Thl型細胞因子[白細胞介素（interleukin，IL）-2、干擾素（interferon，IFN）-γ]和Th2型細胞因子（IL-4、IL-6）表達水平。 結果 乳腺癌組術前外周血IL-2、IFN-γ、IL-4和IL-6的檢測結果在分別為（326.5±67.4）、（288.5±35.6）、（41.2±10.8）、（526.1±136.4） ng/L，手術后分別為（958.1±284.7）、（559.6±106.9）、（26.1± 8.7）、（395.6±125.9） ng/L；在正常對照組分別為（1 498.0±325.9）、（784.6±126.3）、（16.6± 3.7）、（297.4± 83.7） ng/L。與正常對照組相比，術前乳腺癌患者外周血Th1型細胞因子表達降低，Th2型細胞因子表達升高，差異有統計學意義（Plt;0.05）；與術前相比，乳腺癌患者術后Thl型細胞因子表達升高，Th2型細胞因子表達降低，差異有統計學意義（Plt;0.05）。 結論 ①乳腺癌患者Th細胞呈現Th1抑制和Th2極化狀態，細胞免疫受抑制。②手術切除腫瘤可在早期一定程度上逆轉Th1/Th2的失衡狀態，改善機體免疫狀態，對預后產生積極作用。【Abstract】 Objective To investigate the expression and significance of helper T lymphocyte(Th) 1 and 2 of breast cancer patients in vivo before and after operation. Methods From November 2009 to December 2010, Thl-type cytokines [interleukin-2 (IL-2), interferon-γ (IFN-γ)] and Th2-type cytokines (IL-4, IL-6) expression in supernatants of peripheral blood mononuclear cells (PBMC) were detected by enzyme-linked immunosorbent assay (ELISA) in 40 breast cancer patients before and after surgery (Breast cancer group) and 15 healthy women (Control group). Results The test results of IL-2, IFN-γ, IL-4 and IL-6 in peripheral blood for patients of breast cancer group were (326.5±67.4), (288.5±35.6), (41.2±10.8), and (526.1±136.4) ng/L before surgery, and (958.1±284.7), (559.6±106.9), (26.1±8.7), and (395.6±125.9) ng/L after surgery. Those results for patients in the normal control group were (1498.0±325.9), (784.6±126.3), (16.6±3.7), and (297.4±83.7) ng/L respectively. Compared with the control group, the expression of peripheral blood Th1-type cytokines in pre-operative breast cancer patients was significantly lower, while expression of Th2-type cytokines was significantly higher (Plt;0.05); Compared with the pre-operative data, the expression of peripheral blood Th1-type cytokines in post-operative breast cancer patients was significantly higher, and the expression of Th2-type cytokines was significantly lower (Plt;0.05). Conclusions ①For Th cells in breast cancer patients, there is a tendency of Th1 suppression and Th2 polarization, and cellular immunity is suppressed. ②To some extent, surgical removal of tumors can reverse the Th1/Th2 imbalance early, improve the immune status, and has a positive effect on the prognosis.
Objective To summarize the therapeutic efficacy of laparoscope， duodenoscope， and choledochoscopein treatment for elderly patients with common bile duct stones associated with acute severe cholangitis. Methods Eighty-six patients with common bile duct stones associated with severe acute cholangitis from May 2008 to December 2012 in this hospital were chosen. The operation methods and their therapeutic efficacy were analyzed. Results ① Thirty-one patients were performed by laparoscopic cholecystectomy （LC） plus common bile duct discission combined with choledo-choscope for removing the stones， which were completely successful. One case of bile duct perforation happened. The total effective rate was 96.77%（30/31）. The hospital stay was （9.05±2.11） d， the hospital costs was （1.47±0.34） ten thousand yuan. ② Forty-three patients were performed by LC combined with duodenoscopic papillotomy， 42 patients were successful，one patients was turned to the other operation， the retained calculus was found in two patients. The total effective rate was 97.67%（42/43）. The hospital stay was （8.64±1.20） d， the hospital costs was （2.36±0.62） ten thousand yuan. ③ Twelve patients were performed by endoscopic nasobiliary drainage and LC plus common bile duct discission combined with choledochoscope for removing the stones， which were completely successful. The total effective rate was 91.67%（11/12）. The hospital stay was （11.06±2.33） d， the hospital costs was （2.79±0.41） ten thousand yuan. No severe complications such as intestinal perforation， hemorrhea， and severe acute pancreatitis and no death happened. Conclusions Three-endoscopy in treatment for elderly patients with common bile duct stones associated with severe acute cholangitis has a good therapeutic efficacy， a suitable operation is chosen according to the different conditions of the patients， the success rate is high， the complication rate and the mortality rate are low.
