Moriwaki Yoshihiro, Sugiyama Mitsugi, Ozawa Yukihiro, Mochizuki Yasuhisa, Kunisaki Chikara, Kamiya Noriyuki, Yamazaki Yasunobu, Suda Takashi
Department of Critical Care and Emergency Medicine, Yokohama City University, School of Medicine, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
World J Surg. 2002 May;26(5):521-6. doi: 10.1007/s00268-001-0293-z. Epub 2002 Feb 25.
Endotoxin (ETX) primes polymorphonuclear cells (PMNs) for the subsequent release of reactive oxygen species (ROS) in response to various stimulants such as phorbol myristate acetate (PMA). Although PMNs contribute to oxidative stress after stimulation by standard stimulants and after priming by many humoral factors, it is unknown whether the PMNs from patients at different postoperative times exhibit the same response to the same standard stimulant. We examined the response of PMA-induced production of ROS from PMNs at various intervals after major abdominal surgery in response to ETX priming. This study was a prospective clinical and laboratory study conducted over a 7-day period that involved 25 patients who were referred for elective major abdominal surgery (8 for gastric cancer, 9 for colonic cancer, 8 for rectal cancer). Blood was sampled on the day before operation and on postoperative days (PODs) 1, 3, and 7. For each sample we measured luminol-dependent chemiluminescence (CL), the time to peak counts (Tmax) of PMNs stimulated by PMA, and the serum ETX level. We studied the correlation between CL and ETX in samples from PODs 1 and 3. We also studied the CL of PMNs on PODs 1 and 3 preincubated (primed) with various concentrations of ETX (0, 20, 40, 60, and 100 pg/ml). We found that CL decreased on POD 1 compared with the preoperative level (p <0.05) because of the decreased Tmax. The level of CL per 1 ml of whole blood, however, was higher on PODs 1 and 3 than preoperatively. During this time, leukocytosis should compensate for the impaired production of ROS by an individual PMN. The serum ETX level was increased on POD 1 (p <0.05). There was a negative correlation between CL and ETX on POD 1 (correlation coefficient ?0.62, p < 0.01) and a positive correlation on POD 3 (0.61, p <0.01). CL on POD 3 was accelerated by ETX priming, but the CL on POD 1 was depressed by the priming using a low concentration of ETX. The mode of the response of PMNs to ETX priming differed between PODs 1 and 3. On POD 1 the responses of PMNs to environmental stimulants is suppressed, but by POD 3 these responses had increased.
内毒素（ETX）可使多形核白细胞（PMN）对后续诸如佛波酯（PMA）等各种刺激物产生的活性氧（ROS）释放做好准备。尽管PMN在受到标准刺激物刺激后以及在许多体液因子引发作用后会导致氧化应激，但不同术后时间患者的PMN对相同标准刺激物的反应是否相同尚不清楚。我们研究了腹部大手术后不同时间点，PMN对ETX引发作用下PMA诱导产生ROS的反应。本研究是一项为期7天的前瞻性临床和实验室研究，涉及25例因择期腹部大手术而转诊的患者（8例胃癌、9例结肠癌、8例直肠癌）。在手术前一天以及术后第1、3和7天采集血液样本。对于每个样本，我们测量了鲁米诺依赖性化学发光（CL）、PMA刺激的PMN峰值计数时间（Tmax）以及血清ETX水平。我们研究了术后第1天和第3天样本中CL与ETX之间的相关性。我们还研究了用不同浓度ETX（0、20、40、60和100 pg/ml）预孵育（引发）的术后第1天和第3天PMN的CL。我们发现，由于Tmax降低，术后第1天的CL与术前水平相比有所下降（p<0.05）。然而，每1 ml全血的CL水平在术后第1天和第3天高于术前。在此期间，白细胞增多应可弥补单个PMN产生ROS能力的受损。术后第1天血清ETX水平升高（p<0.05）。术后第1天CL与ETX呈负相关（相关系数−0.62，p<0.01），术后第3天呈正相关（0.61，p<0.01）。术后第3天的CL因ETX引发而加速，但术后第1天的CL在低浓度ETX引发时受到抑制。术后第1天和第3天PMN对ETX引发的反应模式不同。术后第1天PMN对环境刺激的反应受到抑制，但到术后第3天这些反应有所增强。
