Laboratory of Biostructure, Human Anatomy Department, Medical University of Lublin, Jaczewskiego 4, 20-094 Lublin, Poland.
Surg Endosc. 2013 Mar;27(3):872-9. doi: 10.1007/s00464-012-2527-6. Epub 2012 Oct 6.
Obesity has become a global epidemic and a leading metabolic disease in the world. Laparoscopic surgeries may influence the function of the immunologic system. The percentages of CD4+ and CD8+ T lymphocyte cells have been described as prognostic factors for patients undergoing abdominal surgeries. This study aimed to evaluate the changes in CD4+ and CD8+ T lymphocyte cells, the ratio of CD4+ to CD8+ cells, and the ZAP-70 kinase expression on T CD3+ and B CD19+ cells in obese and normal-weight individuals undergoing laparoscopic cholecystectomy (LC).
The study group consisted of 46 asymptomatic patients with gallstones shown by ultrasound examination but without signs of any gallbladder complications. The patients underwent planned LC. Blood samples were obtained at three times, and the percentages of studied cells were measured by flow cytometry. Patients were enrolled to two groups: N group (body mass index [BMI], ≤ 25 kg/m(2)) and O group (BMI, ≥ 30 kg/m(2)). For statistical analysis, the Mann-Whitney U test and the Wilcoxon matched-pairs signed-ranks test were used. All p values lower than 0.05 were considered significant.
The percentage of CD4+ T cells did not differ between the N and O groups before or after the surgery. Only in the N group did the percentage of CD4+ lymphocytes increase from 0 to 48 h. A higher percentage of CD8+ lymphocytes was observed in the O group postoperatively than in the N group. Differences of ZAP-70 kinase expression in the O group were observed at 24 and 48 h of the study. Decreased expression of ZAP-70 kinase was shown in the N group at both 0-24 and 24-48 h. In the O group, this tendency was noted at 24-48 h.
Immunologic activation after LC was confirmed in both weight groups. However, higher modulation, more typical for open surgeries, was observed in the obese group.
肥胖已成为全球性流行病，也是世界范围内主要的代谢疾病。腹腔镜手术可能会影响免疫系统的功能。CD4+和 CD8+T 淋巴细胞的百分比已被描述为接受腹部手术患者的预后因素。本研究旨在评估超重和正常体重个体行腹腔镜胆囊切除术（LC）后 CD4+和 CD8+T 淋巴细胞、CD4+/CD8+细胞比值以及 T 细胞 CD3+和 B 细胞 CD19+上 ZAP-70 激酶表达的变化。
研究组由 46 例经超声检查显示无症状胆囊结石但无任何胆囊并发症迹象的患者组成。患者行计划行 LC。在三个时间点采集血样，并通过流式细胞术测量研究细胞的百分比。患者被纳入两组：N 组（体重指数[BMI]，≤25 kg/m2）和 O 组（BMI，≥30 kg/m2）。统计分析采用 Mann-Whitney U 检验和 Wilcoxon 配对符号秩检验。所有 p 值<0.05 被认为有统计学意义。
N 组和 O 组患者术前和术后 CD4+T 细胞百分比无差异。仅 N 组患者的 CD4+淋巴细胞百分比从 0 增加到 48 小时。O 组患者术后 CD8+淋巴细胞百分比高于 N 组。研究 24 和 48 小时时 O 组 ZAP-70 激酶表达存在差异。N 组在 0-24 和 24-48 小时时显示 ZAP-70 激酶表达降低。O 组在 24-48 小时时观察到这种趋势。
LC 后在两组患者中均证实存在免疫激活。然而，在肥胖组中观察到更高的调制，这更典型于开放性手术。
