Holzer K, Richter A, Konietzny P, Schübel F, Wilhelm K, Henrich D
Klinik für Allgemein- und Gefässchirurgie, Universitä tsklinik Frankfurt/Main.
Zentralbl Chir. 2003 Apr;128(4):291-7. doi: 10.1055/s-2003-38792.
Aim of the study was to characterize different functions of circulating and emigrated, intra-abdominal polymorphonuclear leukocytes (cPMNs, ePMNs) during human secondary peritonitis.
In patients (n=25) with diffuse secondary peritonitis circulating and emigrated PMNs were characterized intra- and until 96 h postoperatively. Patients were allocated to two different groups, e. g. patients with septic complications (shock, organ failure, n=11) and patients without complications (n=14) during peritonitis. In addition a control group of patients (n=10) with abdominal surgery but without peritonitis was investigated. The lucigenin- and luminol-enhanced chemiluminescence was used to determine extra- and intracellular oxygen radical generation of PMNs. Besides spontaneous oxygen radical generation of PMNs, stimulated radical production was investigated after the addition of ionophores A23 187 and C3-coated zymosan. Phagocytosis by PMNs was characterized with opsonized E. coli bacteria and fluorescence-activated cell analysis.
Especially patients with complicated peritonitis had strong and long-lasting changes of PMNs functions. The toxic and tissue-destroying production of extracellular oxygen radicals by circulating PMNs was enhanced (e. g., A23 187 - stimulated oxygen radical generation 433 +/- 89 cpm/cPMNs (peritonitis with complications) versus 90 +/- 30 cpm/cPMNs (peritonitis without complications) versus 110 +/- 44 cpm/cPMNs (controls), p < 0.05). Phagocytosis (58 +/- 9 % (ePMNs, peritonitis with complications) versus 81 +/- 6 % (ePMNs, peritonitis without complications) versus 82.2 +/- 1.6 % (ePMNs, controls), p < 0.05) and phagocytosis-associated intracellular oxygen radical generation (8.23 +/- 1.6 x 10(3) cpm/ePMNs (peritonitis with complications) versus 25.2 +/- 5.2 x 10(3) cpm/ePMNs (peritonitis without complications) versus 11.7 +/- 2.8 cpm x 10(3) cpm/ePMNs (controls) p < 0.05) were suppressed.
Not for all patients with peritonitis does it seem favourable to modulate PMNs-functions. If immunomodulation would be able to down-regulate exaggerated functions of circulating PMNs and to up-regulate the suppressed functions of emigrated PMNs patients with complicated peritonitis might benefit from this therapy.
本研究的目的是描述人类继发性腹膜炎期间循环和迁移至腹腔内的多形核白细胞（cPMNs，ePMNs）的不同功能。
对25例弥漫性继发性腹膜炎患者循环和迁移的多形核白细胞进行术中及术后96小时内的特征分析。患者被分为两组，即腹膜炎期间出现感染性并发症（休克、器官衰竭，n = 11）的患者和无并发症（n = 14）的患者。此外，还对10例接受腹部手术但无腹膜炎的患者组成的对照组进行了研究。采用光泽精和鲁米诺增强化学发光法测定多形核白细胞细胞外和细胞内氧自由基的产生。除了多形核白细胞的自发氧自由基产生外，在加入离子载体A23187和C3包被的酵母聚糖后，还研究了刺激后的自由基产生。用调理后的大肠杆菌和荧光激活细胞分析法对多形核白细胞的吞噬作用进行了表征。
尤其是伴有并发症的腹膜炎患者，其多形核白细胞功能发生了强烈且持久的变化。循环多形核白细胞产生细胞外氧自由基的毒性和组织破坏作用增强（例如，A23187刺激的氧自由基产生量为433±89 cpm/cPMNs（伴有并发症的腹膜炎），而无并发症的腹膜炎为90±30 cpm/cPMNs，对照组为110±44 cpm/cPMNs，p<0.05）。吞噬作用（58±9%（ePMNs，伴有并发症的腹膜炎），而无并发症的腹膜炎为81±6%（ePMNs），对照组为82.2±1.6%（ePMNs），p<0.05）以及与吞噬作用相关的细胞内氧自由基产生（8.23±1.6×10³ cpm/ePMNs（伴有并发症的腹膜炎），而无并发症的腹膜炎为25.2±5.2×10³ cpm/ePMNs，对照组为11.7±2.8×10³ cpm/ePMNs，p<0.05）均受到抑制。
并非所有腹膜炎患者调节多形核白细胞功能都是有利的。如果免疫调节能够下调循环多形核白细胞的过度功能，并上调迁移多形核白细胞的受抑制功能，伴有并发症的腹膜炎患者可能会从这种治疗中获益。
