Immune perturbations in patients along the perioperative period: Alterations in cell surface markers and leukocyte subtypes before and after surgery
Immune perturbations in patients along the perioperative period: Alterations in cell surface markers and leukocyte subtypes before and after surgery
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DOI：
10.1016/j.bbi.2009.02.010
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发表时间：
2010-03-01
影响因子：
15.1
通讯作者：
Ben-Eliyahu, Shamgar
中科院分区：
文献类型：
--
作者：
Bartal, Inbal;Melamed, Rivka;Ben-Eliyahu, Shamgar
背景：手术使患者容易出现危及生命的并发症，包括感染、多器官衰竭和可能的癌症转移。手术引起的免疫扰动被认为会导致这种有害影响，但也会促进损伤后的愈合。术前的心理和生理应激反应可能会导致这些免疫扰动，因此甚至在手术前就可能危及患者。目前的研究评估了围手术期各种手术对一系列免疫指标的影响。为了验证手术前的免疫变化，还将患者的免疫状态与健康对照进行了比较。方法：共有 81 名受试者（手术患者和健康对照）在围手术期每天提供最多 5 份血液样本，用于评估白细胞亚型（粒细胞、单核细胞、Tc、Th、NK、NKT、CD4(+)CD25(+)、CD8(bright)CD4(dim) 和 B 细胞）及其表面标志物（HLA-DR 和 LFA-1）。结果：即使在手术前，患者也表现出免疫紊乱，包括淋巴细胞 HLA-DR 表达减少和单核细胞 LFA-1 表达增加。手术后，我们记录到亚型特异性淋巴细胞数量减少，粒细胞数量增加，淋巴细胞和单核细胞的 HLA-DR 表达减少。最后，在白细胞数量的变化和细胞表面标志物之间没有发现显着的关联（尽管这些指数显示出与其他变量的高度相关性），这意味着不同的介导机制。结论：一些免疫改变在手术前就已表现出来，并导致术后明显的变化，这些变化通常被解释为免疫抑制。我们讨论在自然损伤、压力和手术的背景下这些扰动可能的适应性和适应不良性质。 (C) 2009 Elsevier Inc. 保留所有权利。
Background: Surgery renders patients susceptible to life-threatening complications, including infections, multiple organ failure, and presumably cancer metastases. Surgery-induced immune perturbations were suggested to contribute to such deleterious effects, but also to facilitate post-injury healing. Preoperative psychological and physiological stress responses may contribute to these immune perturbations, and could thus jeopardize patients even before surgery. The current study assessed the effects of various operations on an array of immune indices during the perioperative period. To qualify immune changes before surgery, patients' immune status was also compared to that of healthy controls. Methods: A total of 81 subjects (operated patients and healthy controls) provided up to five daily blood samples during the perioperative period, for assessment of leukocyte subtypes (granulocytes, monocytes, Tc, Th, NK, NKT, CD4(+)CD25(+), CD8(bright)CD4(dim), and B cells) and their surface markers (HLA-DR and LFA-1). Results: Even before surgery patients displayed immune perturbations, including reduced lymphocyte HLA-DR expression and increased monocyte LFA-1 expression. Following surgery, we recorded a reduction in lymphocyte numbers that was subtype specific, increased granulocyte numbers, and reduced expression of HLA-DR by lymphocytes and monocytes. Finally, no significant associations were found between alteration in leukocyte numbers and cell surface markers (although these indices showed high correlations with other variables), implying differential mediating mechanisms. Conclusion: Several immune alterations are manifested prior to surgery, and contribute to the marked postoperative changes, which are commonly interpreted as immune suppression. We discuss the possible adaptive and maladaptive nature of these perturbations in the context of natural injury, stress, and surgery. (C) 2009 Elsevier Inc. All rights reserved.