Mauser Martin, Kruger Deirdré, Pather Sugeshnee, Plani Frank
Department of Surgery, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, York Road, Johannesburg, Parktown, Gauteng, South Africa.
Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, York Road, Johannesburg, Parktown, Gauteng, South Africa.
World J Surg. 2021 Apr;45(4):1006-1013. doi: 10.1007/s00268-020-05899-z. Epub 2021 Jan 12.
The gut associated lymphoid tissue (GALT) is an important part of the immune system and compromised in HIV treatment-naïve as well as in HIV-seropositive patients on antiretroviral treatment (ART) due to HIV-induced changes. The influence of the impaired GALT on the postoperative complication rate after surgery for penetrating abdominal trauma has not been investigated and the hypothesis that the HIV-induced changes of the GALT contribute to septic complications postoperatively was tested.
This prospective study included patients who required a small bowel resection due to abdominal gunshot wounds. A bowel specimen was obtained in the index operation, and the T-lymphocytic quantity in the specimen was analyzed via immunohistochemistry to scrutinize whether these lymphocyte numbers had an impact on the postoperative outcome. Septic and postoperative complications were documented during the in-hospital course and the first month after discharge.
In total, 62 patients were included in the study of which 38 patients were HIV-seronegative and 24 were HIV-seropositive. HIV-seropositive patients had a significantly lower quantity of CD4 + T cells in the GALT compared to the HIV-seronegative patients (p = 0.0001), which was also associated with a significantly higher rate of septic complications in the postoperative course. In the HIV-seropositive group, no significant differences were detected for T-lymphocytic quantity in the GALT between the HIV-treatment naïve and antiretroviral treatment groups.
The compromised GALT in HIV-seropositive patients may predispose these patients to postoperative septic complications. Antiretroviral therapy does not result in an adequate immune reconstitution in this tissue.
肠道相关淋巴组织（GALT）是免疫系统的重要组成部分，在未接受过HIV治疗的患者以及接受抗逆转录病毒治疗（ART）的HIV血清阳性患者中，由于HIV引起的变化而受到损害。GALT受损对腹部穿透伤手术后并发症发生率的影响尚未得到研究，我们检验了HIV引起的GALT变化导致术后脓毒症并发症的假设。
这项前瞻性研究纳入了因腹部枪伤需要进行小肠切除术的患者。在初次手术中获取肠道标本，通过免疫组织化学分析标本中的T淋巴细胞数量，以检查这些淋巴细胞数量是否对术后结果有影响。在住院期间和出院后的第一个月记录脓毒症和术后并发症。
该研究共纳入62例患者，其中38例为HIV血清阴性，24例为HIV血清阳性。与HIV血清阴性患者相比，HIV血清阳性患者GALT中CD4 + T细胞数量显著减少（p = 0.0001），这也与术后脓毒症并发症发生率显著升高相关。在HIV血清阳性组中，未接受过HIV治疗的患者和接受抗逆转录病毒治疗的患者之间，GALT中的T淋巴细胞数量未检测到显著差异。
HIV血清阳性患者中受损的GALT可能使这些患者易发生术后脓毒症并发症。抗逆转录病毒疗法在该组织中并未导致充分的免疫重建。
