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目的观察门静脉高压症(PH)脾亢脾脏巨噬细胞(MΦ)数量及其吞噬功能的变化,为进一步探讨PH脾功能亢进(脾亢)的发病机制提供依据。方法取20例PH脾亢患者的手术脾脏作为PH组,按脾脏肿大程度的分级标准,再分为中度肿大组(11例)和重度肿大组(9例)。6例正常脾外伤性破裂患者的手术脾脏作为对照组。称重后贴壁法分离培养脾脏MΦ,用细胞计数板在显微镜下计数MΦ的相对数(每g脾脏组织中的MΦ数)并计算MΦ绝对数(整个脾脏内MΦ的总数),鸡红细胞吞噬法计算MΦ的吞噬率和吞噬指数。结果对照组、PH中度和重度脾大组MΦ的相对数分别为(13．13±3．72)×10~5/g、(8．80±0．97)×10~5/g、(7．29±1．33)×10~5/g,PH组比对照组均显著减少(P＜0．01),但PH的两组之间差异无统计学意义(P＞0．05)；PH组脾脏的重量明显增加(P＜0．01),可达正常脾重的3．5～6．0倍(放血后)；各组MΦ的绝对数分别为(1．94±0．55)×10~8、(4．91±1．12)×10~8、(6．86±0．77)×10~8,PH组比对照组均显著增多(P＜0．01),且PH重度肿大组也显著多于中度肿大组(P＜0．01)；各组MΦ的吞噬率和吞噬指数分别为(6,33±0．58)%和(0．07±0．01)、(11．25±2．19)%和(0．14±0．03)、(13．00±2．38)%和(0．16±0．04),PH组比对照组均显著增强(P＜0．01),但PH的两组之间比较差异无统计学意义(P＞0．05)。结论PH脾亢时,脾脏MΦ的相对数虽然减少,但绝对数增多,MΦ的吞噬功能增强。MΦ在PH脾亢的形成中可能扮演着非常重要的角色。进一步支持了脾亢发病中的“脾内阻留学说”。
Objective To observe the changes of numbers and phagocytosis of splenic macrophages (MΦ) in patients with portal hypertension (PH) and provide the basis for further exploring the pathogenesis of hypersplenism (hypersplenism). Methods Twenty patients with PH hypersplenism were selected as PH group. According to the grade of splenomegaly, the spleen was divided into moderate and severe enlarged group (n = 11) and severe enlarged group (n = 9). Six cases of normal spleen traumatic rupture of patients with spleen as a control group. Spleen MΦ was isolated and cultured after weighed adherent method, and the relative number of MΦ (number of MΦ per g spleen) was counted under the microscope with a cell counting plate, and the absolute number of MΦ (the total number of MΦ in the whole spleen) Method to calculate the phagocytic rate of MΦ and phagocytic index. Results The relative numbers of MΦ in PH moderate and severe splenomegaly group were (13.13 ± 3.72) × 10-5 / g, (8.80 ± 0.97) × 10-5 / g, (7.29 ± 1.33) × 10 ~ (5) / g, the PH group was significantly lower than the control group (P <0.01), but there was no significant difference between the two groups (P> 0.05 ); The weight of spleen in PH group increased significantly (P <0.01), up to 3.5 ~ 6.0 times of normal spleen weight (after exsanguination); The absolute numbers of MΦ in each group were (1.94 ± 0 .55) × 10 ~ 8, (4.91 ± 1.12) × 10 ~ 8 and (6.86 ± 0.77) × 10 ~ 8, respectively. ), And the group with PH severe enlargement was also significantly more than that with moderate enlargement (P <0.01). The phagocytic rate and phagocytic index of MΦ in each group were (6,33 ± 0.58)% and (0. 07 ± 0.01), (11.25 ± 2.19)% and (0.14 ± 0.03), (13.00 ± 2.38)% and (0.16 ± 0.04), respectively (P <0.01), but there was no significant difference between the two groups (P> 0.05). Conclusions Although the relative number of MΦ in spleen is decreased when pH is hypersensitive, the absolute number increases and phagocytosis of MΦ increases. MΦ may play a very important role in the formation of PH hypersplenism. Further support for the pathogenesis of hypersplenism “spleen retention theory.”