Changes of Thl/Th2 balance and serum cytokine levels in critically ill patients.

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OBJECTIVE : To analysis on changes of cellular immune functions and serum cytokine levels for several bodily insults.RESEARCH 1 : Patients who underwent surgery for gastrointestinal malignancies were divided into two groups, with or without postoperative infection. In the preoperative state, the proportions of IFN-y -producing CD4^+ T (Th l) cells, which were detected by intracellular cytokine stainings using flow cytometry, were almost equal in the two groups, and the proportion decreased on POD 1 in both groups. On POD 7, the proportion of Thl cells recovered to the preoperative level in the non-infection group, while the suppression was further reinforced in the infection group. In contrast, the proportion of IL-4-producing CD4^+ T (Th2) cells showed little change through the course in both groups. Changes of HLA-DR and CD16 expression on monocytes were similar to those of the proportion of Thl cells. There were no differences on changes of serum cytokine levels between the two grou … More ps.RESEARCH 2 : Patients with sepsis were allocated into two groups : group 1, those who received an omega-3 fatty acids-enriched enteral diet ; group 2, those who received a conventional enteral diet. Peripheral blood samples were collected from each patient on days 1, 4, and 8 of feeding. Serum concentrations of CRP and IL-6 gradually decreased as time passed in both groups, and there was no difference in their concentrations between the two groups. The proportion of Th2 subset in CD4^+ T cells was almost unchanged through the course in both groups. In contrast, the proportion of Thl subset in group 1 patients significantly increased on day 8 comparing with that on day 1, while that in group 2 patients showed little. HLA-DR expression on monocytes was also significantly increased in group 1, whereas only a slight increase was found in group 2.CONCLUSIONS : These results suggest that bodily insults quickly induce the suppression of Thl cell functions, which may correlate with the occurrence of infection, and that omega-3 fatty acid-enriched enteral nutrition may be beneficial to activate cellular immunity for critically ill patients. Less