【摘要】 目的 观察手术前后乳腺癌患者体内辅助性T淋巴细胞（helper T lymphocyte，Th） 1、2型细胞因子的表达及意义。 方法 2009年11月－2010年12月，采用酶联免疫吸附试验检测40例乳腺癌患者（乳腺癌组）手术前、后和15例健康妇女（正常对照组）外周血单个核细胞培养上清液中Thl型细胞因子[白细胞介素（interleukin，IL）-2、干扰素（interferon，IFN）-γ]和Th2型细胞因子（IL-4、IL-6）表达水平。 结果 乳腺癌组术前外周血IL-2、IFN-γ、IL-4和IL-6的检测结果在分别为（326.5±67.4）、（288.5±35.6）、（41.2±10.8）、（526.1±136.4） ng/L，手术后分别为（958.1±284.7）、（559.6±106.9）、（26.1± 8.7）、（395.6±125.9） ng/L；在正常对照组分别为（1 498.0±325.9）、（784.6±126.3）、（16.6± 3.7）、（297.4± 83.7） ng/L。与正常对照组相比，术前乳腺癌患者外周血Th1型细胞因子表达降低，Th2型细胞因子表达升高，差异有统计学意义（Plt;0.05）；与术前相比，乳腺癌患者术后Thl型细胞因子表达升高，Th2型细胞因子表达降低，差异有统计学意义（Plt;0.05）。 结论 ①乳腺癌患者Th细胞呈现Th1抑制和Th2极化状态，细胞免疫受抑制。②手术切除肿瘤可在早期一定程度上逆转Th1/Th2的失衡状态，改善机体免疫状态，对预后产生积极作用。【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.