Takeyama Y, Takas K, Ueda T, Hori Y, Goshima M, Kuroda Y
First Department of Surgery, Kobe University School of Medicine, Kobe, Japan.
J Gastrointest Surg. 2000 Jul-Aug;4(4):379-87. doi: 10.1016/s1091-255x(00)80016-5.
To investigate impairment of cellular immunity in severe acute pancreatitis, alterations of peripheral lymphocytes in acute pancreatitis were examined. In 48 patients with severe acute pancreatitis, the mean peripheral lymphocyte count on admission was 959 + 105/mm3, and it was significantly decreased in the patients with subsequent infection (623 +/- 90/mm3 ) in comparison to those without infection (1084 +/- 135/mm(3)). According to an analysis of lymphocyte subsets, although both B and T lymphocytes were decreased in peripheral circulation in the patients with infection, it was primarily CD8-positive lymphocytes that decreased in these subsets. Cell cycle analysis of lymphocytes collected from these patients indicated that apoptotic changes occurred after 24 hours' incubation in lymphocytes from patients with severe pancreatitis but not in lymphocytes from healthy control subjects. In a rat model of experimental necrotizing pancreatitis, total peripheral lymphocytes and T lymphocytes were significantly decreased 5 hours after induction of pancreatitis. In severe pancreatitis, peripheral lymphocytes are eliminated from systemic circulation possibly as a result of apoptosis. It has been suggested that impairment of cellular immunity due to peripheral lymphocyte apoptosis is linked to the development of subsequent infectious complications in acute pancreatitis.
为研究重症急性胰腺炎患者细胞免疫功能的损害情况，对急性胰腺炎患者外周血淋巴细胞的变化进行了检测。48例重症急性胰腺炎患者入院时外周血淋巴细胞平均计数为959 + 105/mm³，继发感染患者（623 +/- 90/mm³）与未感染患者（1084 +/- 135/mm³）相比，该计数显著降低。淋巴细胞亚群分析显示，尽管感染患者外周血中B淋巴细胞和T淋巴细胞均减少，但主要是这些亚群中的CD8阳性淋巴细胞减少。对这些患者采集的淋巴细胞进行细胞周期分析表明，重症胰腺炎患者的淋巴细胞在培养24小时后发生凋亡变化，而健康对照者的淋巴细胞未出现这种变化。在实验性坏死性胰腺炎大鼠模型中，胰腺炎诱导后5小时外周血总淋巴细胞和T淋巴细胞显著减少。在重症胰腺炎中，外周血淋巴细胞可能因凋亡而从全身循环中清除。有人提出，外周血淋巴细胞凋亡导致的细胞免疫功能损害与急性胰腺炎继发感染并发症的发生有关。
