Miki Chikao, Ohmori Yukinari, Yoshiyama Shigeyuki, Toiyama Yuji, Araki Toshimitsu, Uchida Keiichi, Kusunoki Masato
Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, 514-8507, Tsu, Mie, Japan.
World J Surg. 2007 Mar;31(3):522-9; discussion 530-1. doi: 10.1007/s00268-006-0131-4.
Positive outcomes after restorative proctocolectomy are compromised by a number of specific septic complications. However, there is no useful perioperative marker predicting postoperative infectious complications (PICs) in steroid overdosed patients with ulcerative colitis (UC).
To determine factors associated with PICs and their relation to circulating levels of pro- and anti-inflammatory cytokines and neutrophil elastase (NE), we obtained perioperative blood samples from 60 UC patients.
Postoperative infectious complications were identified in 47% of cases. Patients who developed PICs had significantly longer disease duration, had been administered a greater total preoperative dosage of prednisolone, and had a higher body mass index. Logistic regression analysis showed that the total preoperative dosage of prednisolone was independently associated with the development of PICs. These patients showed suppressed systemic inflammation and pro- and anti-inflammatory cytokine induction. An early increase in the NE level was found to be predictive of PICs in the high-dose group, whereas there was no significant difference in neutrophil counts between the high- and low-dose groups.
Circulating NE levels in the early postoperative period might be a useful predictor of PICs in immune-controlled UC patients who received high doses of steroids.
多种特定的感染性并发症会影响结直肠切除术后的良好预后。然而，对于患有溃疡性结肠炎（UC）且使用过量类固醇的患者，尚无有效的围手术期指标可预测术后感染性并发症（PICs）。
为确定与PICs相关的因素及其与促炎和抗炎细胞因子以及中性粒细胞弹性蛋白酶（NE）循环水平的关系，我们收集了60例UC患者的围手术期血样。
47%的病例出现术后感染性并发症。发生PICs的患者病程明显更长，术前泼尼松龙的总给药剂量更大，且体重指数更高。逻辑回归分析表明，术前泼尼松龙的总给药剂量与PICs的发生独立相关。这些患者表现出全身炎症反应以及促炎和抗炎细胞因子诱导受到抑制。发现高剂量组中NE水平的早期升高可预测PICs，而高剂量组和低剂量组之间的中性粒细胞计数无显著差异。
术后早期循环中的NE水平可能是接受高剂量类固醇治疗的免疫控制型UC患者发生PICs的有用预测指标。
