Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma
Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma
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DOI：
10.1016/s0039-6060(96)80118-8
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发表时间：
1996-03-01
期刊：
影响因子：
3.8
通讯作者：
vonRuecker, AA
中科院分区：
文献类型：
--
作者：
Decker, D;Schondorf, M;vonRuecker, AA
背景在手术期间或手术后测量血清细胞因子、垂体激素或急性期蛋白不是量化手术影响的最佳方法。在努力评估手术应激的免疫反应的手段，我们专注于细胞介导的和抗体介导的免疫的变化所示的1型/2型辅助性T细胞（Th 1/Th 2）的平衡。通过比较腹腔镜胆囊切除术（LCE）和传统胆囊切除术（CCE），评价该方法的敏感性。在一项实用的前瞻性研究中，43例有症状的胆石症患者接受了LCE（n = 25）或CCE（n = 18）手术。在手术前24小时、切开前即刻以及手术后2、24和48小时进行血样采集。采用流式细胞术和酶联免疫吸附试验（ELISA）检测细胞表面标志物和细胞因子的产生，以表征Th 1/Th 2平衡。Th 2细胞的活化引起白细胞介素-4（IL-4）的产生和分泌，其上调B细胞上免疫球蛋白E受体（F ae RII，CD 23）的表达。CCE后，患者新鲜分离的外周血单核细胞中植物血凝素诱导的IL-4产生比LCE后增加更多（IL-4，+41% vs +17%; p < 0.05）。此外，CCE后B细胞上的CD 23表达高于LCE（+146%对+63%; p < 0.01）。CD 30是一种属于肿瘤坏死因子受体超家族的膜分子，可能是Th 2活性的重要指标，在接受CCE的患者的T细胞上更高。Th 1反应，其特征是植物血凝素诱导的IFN-γ分泌在外周血单核细胞和上调人类白细胞抗原-DR表达的单核细胞，CCE后低于LCE后。这项研究表明，手术应激诱导Th 1/Th 2平衡向Th 2的转变，表明细胞介导的免疫下调，抗体介导的免疫上调手术后。对这种变化的评估可能具有临床意义，并有助于量化侵入性更小的外科手术。在这项非严格随机研究中比较CCE和LCE时，我们发现LCE是压力较小的手术。
Background. Measuring serum cytokines, pituitary hormones, or acute phase proteins during or after surgery is not an optimal method for quantifying the impact of surgical procedures. In an effort to assess surgical stress by means of the immune response, we focused on changes in cell-mediated and antibody-mediated immunity as illustrated by the type 1/type 2 T-helper (Th1/Th2) cell balance. The sensitivity of this approach was evaluated by comparing laparoscopic and conventional cholecystectomy (LCE, CCE).Methods. In a pragmatic prospective study 43 patients with symptomatic cholelithiasis were operated on either by LCE (n = 25) or CCE (n = 18). Blood sampling was done 24 hours before surgery, immediately before incision, and 2, 24, and 48 hours after surgery. Cell surface markers and cytokine production were used to characterize the Th1/Th2 balance and were measured by means of flow cytometry and enzyme-linked immunosorbent assay techniques.Results. Activation of Th2 cells evokes the production and secretion of interleukin-4 (IL-4), which up-regulates the expression of immunoglobulin E receptors (F ae RII, CD23) on B cells. Phytohemagglutinin-induced IL-4 production in freshly isolated peripheral blood mononuclear cells from patients increased more after CCE than LCE (IL-4, +41% versus +17%; p < 0.05). Also the expression of CD23 on B cells was higher after CCE than LCE (+146% versus +63%; p < 0.01). CD30, a membrane molecule that belongs to the tumor necrosis factor receptor superfamily and probably is an important indicator of Th2 activity, was more elevated on T cells from patients who underwent CCE. The Th1 response, characterized by phytohemagglutinin-induced IFN-gamma secretion in peripheral blood mononuclear cells and up-regulation of human leukocyte antigen-DR expression on monocytes, was lower after CCE than after LCE.Conclusions. This study shows that surgical stress induces a shift in the Th1/Th2 balance toward Th2, suggesting that cell-mediated immunity is down-regulated and antibody-mediated immunity is up-regulated after surgery. The evaluation of this shift may be clinically meaningful and help quantify even less invasive surgical procedures. When comparing CCE and LCE in this not strictly randomized study, we found LCE to be the less stressful procedure.