Właszczyk A, Adamik B, Durek G, Kübler A, Zimecki M
Department of Anesthesiology and Intensive Therapy, Wrocław Academy of Medicine, Poland.
Arch Immunol Ther Exp (Warsz). 1996;44(4):225-34.
The aim of this study was to monitor plasma interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) levels in patients subjected to cardiac surgery under general anesthesia. In addition, proliferation of peripheral blood mononuclear cells (PBMC) to phytohemagglutinin (PHA) and the ability of these cells to secrete lipopolysaccharide-induced IL-6 and TNF-alpha during the observation period was investigated. IL-6 and TNF-alpha levels were measured using bioassays. We found that despite high variability in the postoperative response of the patients, characteristic kinetics in the appearance of the cytokines in plasma could be demonstrated. Most significant phenomenon was an increase of IL-6 level 1 day after operation associated with an inhibition of TNF-alpha concentration. Relatively high, preoperative concentrations of these cytokines were probably elicited by stress. Control, healthy donors, did not exhibit measurable levels of these cytokines. In terms of proliferative response of PBMC to PHA and of cytokine production in vitro, the patients could be classified into low and high responding. The proliferative response of PBMC from low responders was progressively increasing and the response of high responders did not exhibit meaningful changes throughout the observation period. PBMC from low producers of IL-6 showed also an increased ability to secrete this cytokine during the monitoring time while the cells from high producers yielded less IL-6 on the last day of the follow up. Regarding TNF-alpha production, PBMC from low responders reacted strongly by secretion of this cytokine on day 1 after surgery in contrast to high responders whose cells yielded less TNF-alpha after surgery. In majority of cases TNF-alpha production had a tendency to diminish on the last day of observation. We conclude that the changes in cytokine levels as well as an altered reactivity of PBMC in vitro reflect the immune response to the postoperative trauma and are desirable for a normal course of the immune response and wound healing.
本研究的目的是监测在全身麻醉下接受心脏手术患者的血浆白细胞介素6（IL-6）和肿瘤坏死因子α（TNF-α）水平。此外，还研究了观察期内外周血单个核细胞（PBMC）对植物血凝素（PHA）的增殖情况以及这些细胞分泌脂多糖诱导的IL-6和TNF-α的能力。使用生物测定法测量IL-6和TNF-α水平。我们发现，尽管患者术后反应存在高度变异性，但仍可证明血浆中细胞因子出现的特征性动力学。最显著的现象是术后1天IL-6水平升高，同时TNF-α浓度受到抑制。这些细胞因子术前相对较高的浓度可能是由应激引起的。对照健康供体未表现出这些细胞因子的可测量水平。就PBMC对PHA的增殖反应和体外细胞因子产生而言，患者可分为低反应者和高反应者。低反应者的PBMC增殖反应逐渐增加，而高反应者的反应在整个观察期内未表现出有意义的变化。IL-6低分泌者的PBMC在监测期间分泌该细胞因子的能力也有所增加，而高分泌者细胞在随访最后一天产生的IL-6较少。关于TNF-α的产生，低反应者的PBMC在术后第1天通过分泌该细胞因子强烈反应，而高反应者的细胞术后产生的TNF-α较少。在大多数情况下，观察期最后一天TNF-α的产生有减少的趋势。我们得出结论，细胞因子水平的变化以及PBMC体外反应性的改变反映了对术后创伤的免疫反应，并且对于免疫反应和伤口愈合的正常进程是有利的。
