Rosenberger Patricia H, Ickovics Jeannette R, Epel Elissa, Nadler Eric, Jokl Peter, Fulkerson John P, Tillie Jean M, Dhabhar Firdaus S
Department of Orthopaedics, Yale University, New Haven, CT 06510, USA.
J Bone Joint Surg Am. 2009 Dec;91(12):2783-94. doi: 10.2106/JBJS.H.00989.
The experience of undergoing surgery is known to induce a short-term, fight-or-flight physiological stress response. As an optimum immune response at the site of surgery would enhance tissue repair, we examined surgical stress-induced immune cell redistribution profiles as predictors, and potential mediators, of short and long-term postoperative recovery. We tested the a priori hypothesis that predefined adaptive immune cell redistribution profiles observed during surgery will predict enhanced postoperative recovery.
This prospective longitudinal study involved fifty-seven patients undergoing meniscectomy. Knee function was assessed preoperatively and at one, three, eight, sixteen, twenty-four, and forty-eight weeks postoperatively with use of the clinically validated Lysholm scale, which assesses mechanical function, pain, mobility, and the ability to perform daily activities. Surgery-induced immune cell redistribution was measured in the blood at baseline, before surgery, and after surgery.
Mixed-model repeated-measures analyses revealed a main effect of immune cell redistribution: patients who showed the predefined "adaptive" lymphocyte and monocyte redistribution profiles during surgery showed enhanced recovery. Interesting differences were also observed between the sexes: women as a group showed less adaptive redistribution and correspondingly showed significantly delayed maximum recovery, requiring forty-eight weeks, compared with men, who required only sixteen weeks. Inter-individual differences in leukocyte redistribution predicted the rate of recovery across both sexes.
Immune cell redistribution that is induced by the stress of undergoing surgery can predict (and may partially mediate) postoperative healing and recovery. These findings may provide the basis for identifying patients (either prospectively or during surgery) who are likely to show good as opposed to poor recovery following surgery and for designing interventions that would maximize protective immune responses and enhance the rate and extent of recovery.
已知经历手术会引发短期的“战斗或逃跑”生理应激反应。由于手术部位的最佳免疫反应会促进组织修复，我们研究了手术应激诱导的免疫细胞重新分布情况，将其作为短期和长期术后恢复的预测指标以及潜在的调节因子。我们检验了一个先验假设，即在手术过程中观察到的预定义适应性免疫细胞重新分布情况将预测术后恢复的增强。
这项前瞻性纵向研究纳入了57例行半月板切除术的患者。术前以及术后1周、3周、8周、16周、24周和48周使用经过临床验证的Lysholm量表评估膝关节功能，该量表评估机械功能、疼痛、活动能力以及进行日常活动的能力。在基线期、手术前和手术后测量血液中手术诱导的免疫细胞重新分布情况。
混合模型重复测量分析显示免疫细胞重新分布存在主要影响：在手术过程中表现出预定义“适应性”淋巴细胞和单核细胞重新分布情况的患者恢复情况更好。在性别之间也观察到有趣的差异：作为一个群体，女性表现出的适应性重新分布较少，相应地，与仅需16周的男性相比，女性的最大恢复明显延迟，需要48周。白细胞重新分布的个体间差异预测了两性的恢复速度。
手术应激诱导的免疫细胞重新分布可以预测（并可能部分介导）术后愈合和恢复。这些发现可能为识别术后恢复良好或不佳的患者（无论是前瞻性地还是在手术期间）以及设计能够最大化保护性免疫反应并提高恢复速度和程度的干预措施提供依据。
