Systemic Inflammatory Response Syndrome After Major Abdominal Surgery Predicted by Early Upregulation of TLR4 and TLR5
Systemic Inflammatory Response Syndrome After Major Abdominal Surgery Predicted by Early Upregulation of TLR4 and TLR5
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DOI：
10.1097/sla.0000000000001248
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发表时间：
2016-05-01
影响因子：
9
通讯作者：
Alazawi, William
中科院分区：
文献类型：
--
作者：
Lahiri, Rajiv;Derwa, Yannick;Alazawi, William
目的：研究先天性免疫途径，在接受hepatopancreaticobiliary手术的患者，以了解机制，导致增强炎症反应和识别不良的临床consequence.Background生物标志物：接受腹部大手术的患者有危及生命的全身炎症反应综合征（SIRS）和败血症的风险。早期识别有风险的患者将允许量身定制的术后护理和提高survival.Methods：两个独立的队列进行重大hepatopancreaticobiliary手术的患者进行了研究（合并n=69）。在术前、术后第1天和第2天采血。外周血单个核细胞和血清分离和免疫表型和功能评估体外vivo.Results：早期先天免疫功能障碍是明显的，在12例随后发展SIRS（术后第6天）相比，27人没有，当没有临床证据的SIRS是明显的（术前或第1和2天）。SIRS患者血清IL-6浓度和单核细胞Toll样受体（TLR）/NF-B/IL-6功能通路显著上调和过度活跃（P
Objectives:To study innate immune pathways in patients undergoing hepatopancreaticobiliary surgery to understand mechanisms leading to enhanced inflammatory responses and identifying biomarkers of adverse clinical consequences.Background:Patients undergoing major abdominal surgery are at risk of life-threatening systemic inflammatory response syndrome (SIRS) and sepsis. Early identification of at-risk patients would allow tailored postoperative care and improve survival.Methods:Two separate cohorts of patients undergoing major hepatopancreaticobiliary surgery were studied (combined n=69). Bloods were taken preoperatively, on day 1 and day 2 postoperatively. Peripheral blood mononuclear cells and serum were separated and immune phenotype and function assessed ex vivo.Results:Early innate immune dysfunction was evident in 12 patients who subsequently developed SIRS (postoperative day 6) compared with 27 who did not, when no clinical evidence of SIRS was apparent (preoperatively or days 1 and 2). Serum interleukin (IL)-6 concentration and monocyte Toll-like receptor (TLR)/NF-B/IL-6 functional pathways were significantly upregulated and overactive in patients who developed SIRS (P