Sander M, Irwin M, Sinha P, Naumann E, Kox W J, Spies C D
Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Charité Mitte, Humboldt University, Schumannstrasse 20/21, 10117 Berlin, Germany.
Intensive Care Med. 2002 Mar;28(3):285-92. doi: 10.1007/s00134-001-1199-9. Epub 2002 Feb 2.
To investigate the interleukin-6 (IL-6) to interleukin-10 (IL-10) ratio and levels of sE-selectin in patients undergoing elective surgery of the upper digestive tract and to define the differences in the perioperative immune response between chronic alcoholic and non-alcoholic patients.
Prospective pilot study.
Single center, interdisciplinary intensive care unit (ICU) at a university hospital.
The study compared chronic alcoholics ( n=25) and non-alcoholics ( n=20) before and after surgery for resection of upper digestive tract tumors. White blood cell counts, C-reactive protein and circulating levels of sE-selectin, the pro-inflammatory cytokine IL-6 and the inhibitory cytokine IL-10, were obtained at hospital admission, preoperatively, postoperatively at ICU admission and 2 and 4 days later. Rates of postoperative infectious complications including pneumonia and sepsis were determined. sE-selectin only differed between chronic alcoholics and non-alcoholics preoperatively. Compared to non-alcoholics, chronic alcoholic patients showed a fourfold increase in circulating levels of IL-10 ( p<0.01) and a suppression of the IL-6/IL-10 ratio ( p=0.001) immediately after surgery. Coincident with the immune alterations, chronic alcoholics had a prolonged ICU stay ( p<0.01) and a threefold increased rate of wound infections ( p<0.05) and pneumonia ( p<0.01). Lower IL-6/IL-10 ratios were associated with increased rates of infectious complications ( p<0.05).
Chronic alcoholics had decreased IL-6/IL-10 ratios at ICU admission and increased rates of infectious complications in the postoperative ICU course. This may indicate immediate postoperative immune suppression before the onset of infections and may help to identify chronic alcoholic patients at risk.
研究择期上消化道手术患者的白细胞介素-6（IL-6）与白细胞介素-10（IL-10）比值及可溶性E-选择素（sE-selectin）水平，明确慢性酒精性和非酒精性患者围手术期免疫反应的差异。
前瞻性试点研究。
大学医院的单中心跨学科重症监护病房（ICU）。
本研究比较了25例慢性酒精性患者和20例非酒精性患者在上消化道肿瘤切除手术前后的情况。在入院时、术前、术后入住ICU时以及术后2天和4天，检测白细胞计数、C反应蛋白以及sE-selectin、促炎细胞因子IL-6和抑制性细胞因子IL-10的循环水平。确定术后包括肺炎和脓毒症在内的感染性并发症发生率。sE-selectin仅在术前慢性酒精性患者和非酒精性患者之间存在差异。与非酒精性患者相比，慢性酒精性患者术后即刻循环IL-10水平增加四倍（p<0.01），IL-6/IL-10比值受到抑制（p=0.001）。与免疫改变一致，慢性酒精性患者ICU住院时间延长（p<0.01），伤口感染率增加三倍（p<0.05），肺炎发生率增加三倍（p<0.01）。较低的IL-6/IL-10比值与感染性并发症发生率增加相关（p<0.05）。
慢性酒精性患者入住ICU时IL-6/IL-10比值降低，术后ICU病程中感染性并发症发生率增加。这可能表明在感染发生前术后即刻存在免疫抑制，可能有助于识别有风险的慢性酒精性患者。
