Paddison Johanna S, Booth Roger J, Fuchs Dietmar, Hill Andrew G
Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand.
Psychoneuroendocrinology. 2008 May;33(4):446-54. doi: 10.1016/j.psyneuen.2007.12.011. Epub 2008 Feb 7.
The effect of post-surgical inflammation, as indicated by peritoneal cytokines and neopterin, was assessed on the duration and characteristics of post-surgical fatigue (PSF) experiences.
During the weeks following major colorectal surgery, many patients report experiencing substantial fatigue but the physiological factors contributing to this are not well understood. Because cytokines, particularly pro-inflammatory cytokines, have been found to be important in fatigue-related experiences in experimental systems, they may well be important mediators of PSF.
In 27 patients following colorectal surgery, cytokines and neopterin (a relatively stable immune activation marker) were measured in 24-h peritoneal drain fluid and in serum 2, 5 and 14 days post-operatively. Patient fatigue was assessed using the Identity-Consequence Fatigue Scale questionnaire pre-operatively and 2, 5, 14, 30 and 60 days after surgery.
Using linear mixed model analysis controlling for age, gender and ASA score, the trajectory of fatigue experience during the first 2 months of surgical recovery was significantly related to intra-peritoneal concentrations of IL-6, IL-10 and TNF-alpha during the first 24h after surgery, while the trajectory of fatigue impacts was related only to IL-6 and TNF-alpha concentrations. Moreover, correlations between neopterin, and post-operative peritoneal (within 24h of surgery) and serum cytokine concentrations permitted neopterin to be used as a surrogate inflammation marker. Patients with elevated neopterin concentrations during the initial weeks following surgery reported significantly more severe and sustained PSF.
Locally occurring inflammatory responses may influence reports of fatigue following major surgery in a sustained manner, and, as a consequence, reducing inflammation may be effective in reducing PSF.
通过腹膜细胞因子和新蝶呤评估术后炎症对术后疲劳（PSF）经历的持续时间和特征的影响。
在大肠大手术后的数周内，许多患者报告经历了严重的疲劳，但导致这种情况的生理因素尚不清楚。由于细胞因子，特别是促炎细胞因子，已被发现在实验系统中与疲劳相关经历有关，它们很可能是PSF的重要介质。
对27例大肠手术后患者，在术后2、5和14天测量24小时腹膜引流液和血清中的细胞因子和新蝶呤（一种相对稳定的免疫激活标志物）。术前以及术后2、5、14、30和60天使用身份-后果疲劳量表问卷评估患者的疲劳情况。
使用控制年龄、性别和ASA评分的线性混合模型分析，手术恢复的前2个月内疲劳经历的轨迹与术后头24小时内腹腔内IL-6、IL-10和TNF-α的浓度显著相关，而疲劳影响的轨迹仅与IL-6和TNF-α浓度相关。此外，新蝶呤与术后腹膜（手术24小时内）和血清细胞因子浓度之间的相关性使新蝶呤可作为替代炎症标志物。术后最初几周新蝶呤浓度升高的患者报告的PSF明显更严重且持续时间更长。
局部发生的炎症反应可能持续影响大手术后的疲劳报告，因此，减轻炎症可能有效减轻PSF。
