Decker Dorothee, Tolba Rene, Springer Wolfram, Lauschke Holger, Hirner Andreas, von Ruecker Alexander
Department of General, Visceral, Thoracic and Vascular Surgery, University of Bonn, 53105 Bonn, Germany.
J Surg Res. 2005 Jun 1;126(1):12-8. doi: 10.1016/j.jss.2005.01.006.
Little is known about the local accumulation and function of immune cells in peritoneal fluid after elective surgery of the upper and lower gastrointestinal tract. Our study was designed to investigate whether systemic immune cell response mirrors the local response. We focused on the cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha and on monocytes, natural killer (NK) cells, and T cells that play an important role in eliciting the innate and adaptive immune response.
Blood samples were taken prospectively from 25 patients 24 h before surgery, as well as 24 h and 48 h afterward. Abdominal drainage fluids were collected intraoperatively 1 h after the abdomen was opened and 24 h and 48 h postoperatively. Apart from the white blood cells, intracellular T-helper-cell (TH1/TH2) cytokine production (interferon-gamma, IL-2, IL-4, IL-13) and HLA-DR on monocytes were measured by four-color flow cytometry, IL-6, and TNF-alpha with the fast immunoluminescence method.
Cells of the innate immune system (NK cells, monocytes, NK-T cells, CD5(+) B cells) rapidly decreased in abdominal fluids (P < 0.05: +24 h; +48 h) after surgery, which was paralleled by a concomitant decline in peripheral blood. The percentage of abdominal interferon-gamma, IL-2, IL-4, and IL-13-producing TH cells increased in a way that distinctly counteracted the decrease of the natural immune cells. HLA-DR expression on monocytes in peripheral blood declined significantly (P < 0.05: +24 h; +48 h). In contrast, monocytes in abdominal fluids had high HLA-DR expression. Furthermore, abdominal fluids contained significantly higher concentrations of TNF-alpha (P < 0.05: +24 h; +48 h) and IL-6 (P < 0.05: +24 h) compared with peripheral blood.
Specific immune cell recruitment and cytokine production play an important role in post-trauma events. Measuring distinct local immune cell repertoires and cytokines provides answers as to how the different phases of postoperative immune events proceed. The evaluation of the local response may provide additional criteria for the evaluation of operative trauma. This knowledge may be helpful in detecting postoperative pathological aberrancies.
关于上、下消化道择期手术后腹腔液中免疫细胞的局部聚集和功能，人们了解甚少。我们的研究旨在调查全身免疫细胞反应是否反映局部反应。我们重点关注细胞因子白细胞介素（IL）-6和肿瘤坏死因子（TNF）-α，以及在引发先天性和适应性免疫反应中起重要作用的单核细胞、自然杀伤（NK）细胞和T细胞。
前瞻性地采集25例患者术前24小时、术后24小时和48小时的血样。术中在打开腹腔后1小时、术后24小时和48小时收集腹腔引流液。除白细胞外，通过四色流式细胞术检测细胞内辅助性T细胞（TH1/TH2）细胞因子产生（干扰素-γ、IL-2、IL-4、IL-13）以及单核细胞上的HLA-DR，用快速免疫发光法检测IL-6和TNF-α。
先天性免疫系统细胞（NK细胞、单核细胞、NK-T细胞、CD5(+) B细胞）在术后腹腔液中迅速减少（P < 0.05：术后24小时；术后48小时），外周血中也随之下降。腹腔中产生干扰素-γ、IL-2、IL-4和IL-13的TH细胞百分比增加，明显抵消了天然免疫细胞的减少。外周血单核细胞上的HLA-DR表达显著下降（P < 0.05：术后24小时；术后48小时）。相比之下，腹腔液中的单核细胞具有高HLA-DR表达。此外，与外周血相比，腹腔液中TNF-α（P < 0.05：术后24小时；术后48小时）和IL-6（P < 0.05：术后24小时）的浓度明显更高。
特异性免疫细胞募集和细胞因子产生在创伤后事件中起重要作用。测量不同的局部免疫细胞组成和细胞因子可提供关于术后免疫事件不同阶段如何进展的答案。对局部反应的评估可为手术创伤的评估提供额外标准。这些知识可能有助于检测术后病理异常。
