Tashiro T, Yamamori H, Takagi K, Hayashi N, Furukawa K, Nitta H, Toyoda Y, Sano W, Itabashi T, Nishiya K, Hirano J, Nakajima N
Kamitsuga General Hospital, Tochigi, Japan.
Nutrition. 1999 Oct;15(10):760-6. doi: 10.1016/s0899-9007(99)00151-3.
Changes in immune function due to surgical injury have been well-documented. Immunosuppression is one of the causes of infectious complications leading to organ dysfunction in critical illness. It is not known what kind of surgery in the daily clinical practice causes immunosuppression. Stress response and immune function following surgery for esophageal carcinoma, assuming a highly-stressed operation, were studied and then compared with the stress response and immune function following gastric surgery, a moderately-stressed procedure. Forty patients who underwent esophagectomy and 39 patients receiving gastric operation were studied. The concentrations of serum interleukin-6 (IL-6) were measured preoperatively, at 1, 2, and 6 h, and at 1, 3, and 10 d after operation. Total protein, serum albumin, rapid turnover protein, serum CRP, and cortisol were measured before operation and at 1, 3, 7, and 21 d after operation. ConA- and PHA-stimulated lymphocyte proliferation, IgA, IgG, and IgM were also measured preoperatively, and on 7 and 21 d following surgery. The patients were fed exclusively by total parenteral nutrition (TPN). A striking rise of IL-6 was observed, with a peak in both groups at 1 to 6 h following operation. The peak values were 419+/-30 pg/mL, which was approximately twice as high in the esophagectomy patients as in the gastrectomy patients (195+/-40 pg/mL). CRP and cortisol also increased after operation, and these increases were also significantly greater in the esophagectomy patients. ConA- and PHA-stimulated lymphocyte proliferation decreased significantly 7 d after esophagectomy (P<0.05), but was unchanged in the patients receiving gastrectomy. Suppression of cellular immunity correlated significantly with serum cortisol, and was preceded by a rise in serum IL-6. The IgA, IgG, and IgM levels, however, remained unchanged from their preoperative values throughout the study in both groups. Nutritional status in terms of serum protein, albumin, and rapid turnover protein, decreased postoperatively, but there was no difference between the two groups. It is, therefore, concluded that cell-mediated immunosuppression, preceded by a hyperinflammatory response, is an observable reaction in patients following esophageal surgery, but not in patients undergoing gastric surgery.
手术创伤导致的免疫功能变化已有充分记录。免疫抑制是导致危重病患者发生感染并发症并进而引起器官功能障碍的原因之一。目前尚不清楚在日常临床实践中哪种手术会导致免疫抑制。鉴于食管癌手术被认为是一种高应激手术，我们对其术后的应激反应和免疫功能进行了研究，然后与胃手术（一种中度应激手术）后的应激反应和免疫功能进行比较。研究了40例行食管切除术的患者和39例行胃手术的患者。在术前、术后1、2和6小时以及术后1、3和10天测量血清白细胞介素-6（IL-6）浓度。在术前以及术后1、3、7和21天测量总蛋白、血清白蛋白、快速周转蛋白、血清CRP和皮质醇。术前以及术后7天和21天还测量了ConA和PHA刺激的淋巴细胞增殖、IgA、IgG和IgM。患者均通过全胃肠外营养（TPN）进行单纯喂养。观察到IL-6显著升高，两组在术后1至6小时均达到峰值。峰值分别为419±30 pg/mL，食管癌切除患者的峰值约为胃切除患者（195±40 pg/mL）的两倍。术后CRP和皮质醇也升高，且食管癌切除患者的升高幅度也显著更大。食管切除术后7天，ConA和PHA刺激的淋巴细胞增殖显著降低（P<0.05），但胃切除患者无变化。细胞免疫抑制与血清皮质醇显著相关，且在血清IL-6升高之前出现。然而，在整个研究过程中，两组的IgA、IgG和IgM水平与术前值相比均无变化。从血清蛋白、白蛋白和快速周转蛋白方面来看，营养状况术后下降，但两组之间无差异。因此，得出结论：在食管手术后患者中可观察到以高炎症反应为先导的细胞介导的免疫抑制，但在胃手术患者中未观察到。
