Kamel R, Abbas M M, Metwally D M, Ezzat A G, El-Azzazi H, Saleh W A
Department of Surgery, Faculty of Medicine, Ain-Shams University, Cairo 11566, Egypt.
J Egypt Soc Parasitol. 1999;29(1):203-13.
This study was carried out on forty cases, classified into 3 groups; group I: 10 healthy controls subjects, group II: 20 patients with hepatosplenic schistosomiasis and group III: 10 bilharzial patients who underwent total splenectomy. All cases were subjected to clinical examination, abdominal ultrasonography, rectal snips and laboratory investigations which included: stool and urine analysis, complete blood picture, IHAT for bilharziasis, liver function tests, viral markers, estimaton of T-lymphocyte subpopulations (CD(+)3, CD(+)4, & CD(+)8) by flow Cytometry, silver stained blood films to detect argyrophilic inclusions and 99mTc sulphur colloid splenic scan which was applied to group II only. The present results revealed varying degrees of hypersplenism (anaemia, leukopenia & thrombocytopenia) in GII. Seventy percent of this group was positive for HbsAg, HCV or both in association with schistosomiasis. Abnormal red blood cells (acanthocytes, target cells, pitted cells & normoblasts) and inclusion bodies (Howell Jolly bodies, argyrophilic inclusions & pappenhiemer bodies) were detected with different values in GIII. CD(+)4 cells were moderately reduced in GII while they were markedly decreased in GIII. CD(+)8 cells were elevated in GII and returned nearly to the normal values in GIII with decrease in number of total T-lymphocytes. Most patients of GII showed marked squestration of 99mTc labelled R.B.Cs. in the spleen with reversed hepatic/splenic ratio (normally hepatic/splenic ratio is over two). IHAT showed positivity in 90% of patients in GII while it was 50% in GIII. Although total splenectomy improved the haematological pattern and the cytopenias, which are prominent features in hepatosplenic schistosomiasis, yet the immunological profile was still altered. So, it is recommended to perform segmental splenectomy with retention of a normal mass of functioning residual spleen to preserve more immunological function and to protect against life-threatening occurrence of post-splenectomy sepsis.
本研究对40例患者进行，分为3组；第一组：10名健康对照者；第二组：20例肝脾血吸虫病患者；第三组：10例接受全脾切除术的血吸虫病患者。所有病例均接受临床检查、腹部超声检查、直肠活检及实验室检查，包括：粪便和尿液分析、全血细胞计数、血吸虫病间接血凝试验、肝功能检查、病毒标志物检测、通过流式细胞术检测T淋巴细胞亚群（CD(+)3、CD(+)4和CD(+)8）、银染血涂片检测嗜银包涵体以及仅应用于第二组的99mTc硫胶体脾扫描。目前的结果显示第二组存在不同程度的脾功能亢进（贫血、白细胞减少和血小板减少）。该组70%的患者乙肝表面抗原、丙型肝炎病毒或两者均呈阳性，且与血吸虫病相关。在第三组中检测到不同比例的异常红细胞（棘形红细胞、靶形细胞、凹陷细胞和幼红细胞）和包涵体（豪-乔小体、嗜银包涵体和帕彭海默小体）。第二组中CD(+)4细胞中度减少，而在第三组中显著减少。第二组中CD(+)8细胞升高，随着总T淋巴细胞数量减少，第三组中CD(+)8细胞几乎恢复到正常水平。第二组的大多数患者脾脏中99mTc标记的红细胞明显滞留，肝脾比值倒置（正常肝脾比值超过2）。间接血凝试验显示第二组90%的患者呈阳性，而第三组为50%。尽管全脾切除术改善了血液学模式和血细胞减少症，这些是肝脾血吸虫病的突出特征，但免疫状况仍发生改变。因此，建议进行节段性脾切除术，保留正常质量的有功能的残余脾脏，以保留更多免疫功能，并预防脾切除术后脓毒症这一致命并发症的发生。
