Downregulation of T helper type 1 immune response and altered pro-inflammatory and anti-inflammatory T cell cytokine balance following conventional but not laparoscopic surgery
Downregulation of T helper type 1 immune response and altered pro-inflammatory and anti-inflammatory T cell cytokine balance following conventional but not laparoscopic surgery
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DOI：
10.1016/s0002-9610(98)00299-2
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发表时间：
1999-01-01
影响因子：
3
通讯作者：
Siewert, JR
中科院分区：
文献类型：
--
作者：
Brune, IB;Wilke, W;Siewert, JR
背景：腹腔镜手术的临床优势在于手术创伤最小。本研究旨在探讨腹腔镜手术与开放手术后的免疫抑制情况。我们的分析集中在T细胞分泌的细胞因子，这些细胞因子调节T辅助型-1 (Th1)-和th2介导的免疫反应对促炎和抗炎活性的关键平衡。方法：在一项前瞻性研究中，比较26例接受腹腔镜胆囊切除术（LCE）和17例接受常规胆囊切除术（CCE）治疗的症状性胆囊结石患者的免疫学数据。排除急性胆囊炎患者、术后出现并发症或接受免疫抑制药物的患者，术前及术后第1天、第6天或第7天评估CD3和CD28交联刺激分离T细胞产生干扰素(IFN)- γ、白细胞介素(IL)-2、IL-4、肿瘤坏死因子(TNF)- α和IL-10的情况。免疫酶法测定细胞因子。结果：在CCE术后第1天，T细胞产生的ifn - γ、tnf - α和IL-2分别显著下降48.3%、36.6%和36.8%，而LCE后则无明显下降。这些结果表明开放手术后th1型和促炎细胞因子严重抑制。相比之下，IL-4和IL-10在两组中均未出现明显变化，表明Th2细胞反应和抗炎活性保持正常。结论：目前的研究表明，开放而非腹腔镜胆囊切除术与T淋巴细胞功能的明显抑制有关，这表明Th1/Th2和促/抗炎细胞因子平衡的解除。因此，结果表明Th1细胞介导的免疫反应和T细胞促炎活性的下调是开放腹腔镜手术的标志，而不是腹腔镜手术的标志。中华外科杂志。1999;17(1):55-60。(C) 1999年出版的医学摘录公司
BACKGROUND: The clinical advantages of laparoscopic procedures result from a minimized surgical trauma. The present study was performed to investigate immunosupression following laparoscopic operations as compared with open surgery. Our analysis focused on the T cell secretion of cytokines that regulate the critical balance of either T helper type-1 (Th1)- and Th2-mediated immune responses on pro- and antiinflammatory activities.METHODS: In a prospective study, immunological data of 26 patients submitted to laparoscopic cholecystectomy (LCE) and 17 patients undergoing conventional cholecystectomy (CCE) for symptomatic cholecystolithiasis were compared. Patients with acute cholecystitis and patients developing postoperative complications or receiving immunosuppressive medication were excluded, Production of interferon (IFN)-gamma, interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-alpha, and IL-10 by isolated T cells stimulated by crosslinking of CD3 and CD28 was evaluated preoperatively as well as on postoperative days 1 and 6 or 7. Cytokines were measured by immunoenzymometric assay.RESULTS: IFN-gamma, TNF-alpha, and IL-2 production by T cells decreased significantly by 48.3%, 36.6%, and 36.8%, respectively, on postoperative day 1 after CCE, but not after LCE. These results indicate severe suppression of Th1-type and proinflammatory cytokines after the open operation. In contrast, IL-4 and IL-10 did not show significant changes in either group suggesting that Th2 cell response and anti-inflammatory activity remained normal.CONCLUSIONS: The present study shows that open, but not laparoscopic cholecystectomy is associated with a marked suppression of T lymphocytes functions as indicated by deregulation of both the Th1/Th2 and the pro-/anti-inflammatory cytokine balance. The results therefore suggest that downregulation of Th1 cell-mediated immune response and pro-inflammatory activity of T cells is a hallmark of open, but not laparoscopic surgery. Am J Surg. 1999;177:55-60. (C) 1999 by Excerpta Medica, Inc.