Etiology and treatment of postoperative severe infections based on impaired host defense systems in patients with digestive organ cancers

本文主要研究食管癌患者多形核中性粒细胞（PMN）、单核细胞和体液免疫功能障碍与术后感染的关系。体液免疫当比较抗肺炎球菌多糖（PPS）的抗体产生能力时，感染患者的抗PPS IgG水平明显低于未感染患者。已知与抗PPS IgG相关的血清IgG2水平在感染人群中也显著降低。抗PPS Ig低于600 EU或IgG2低于500 mg/dl者术后感染风险较大。食管癌患者pmni细胞杀伤活性（KI）普遍较低，而感染患者的超氧阴离子生成（SOP）明显高于无感染患者。3 .有感染的食管癌患者单核细胞吞噬指数明显低于无感染的食管癌患者，而SOP和细胞因子的分泌水平明显高于无感染的食管癌患者。PMN和单核细胞功能障碍与蛋白质-热量营养不良和慢性阻塞性肺疾病有关。因此，手术前抗体产生能力水平下降是食管癌患者术后感染的重要致病机制。PMN和单核细胞的活化被发现在术后感染的玫瑰中增加了SOP和细胞因子的产生水平，这些测量似乎是有益的，作为术后感染高危患者的预测指标。

Correlation between dysfunctions of polymorphonuclear neutrophils(PMN), monocytes and humoral immunity and postoperative infections was studied mainly in patients with esophageal cancer.1. Humoral immunityWhen antibody producing capacity against pneumococcal polysaccharides (PPS) was compared, the levels of anti PPS IgG was significantly lower in patients with infections than those without infections. Serum IgG2 levels which are knouwn to be correlated to anti PPS IgG were also significantly lower in those with infections. Those in whom anti PPS Ig was under 600 EU, or IgG2 was under 500 mg/dl seem to be risky for postoperative infections.2. Cytocidal function of PMNIntracellular killing activity (KI) was generally lower in patients with esophageal cancer while superoxide anion production (SOP) was significantly higher in patients with infections than those without such problems.3. MonocytesPhagocytic index was significantly lower in patients with esphageal cancer while the levels of SOP and cytokine production were significantly enhanced in patients with infections than those without such problems.4. Causes of dysfunctionDyofunctions of PMN and monocytes were associated with protein-calorie malnutrition and chronic obstructive pulmonary diseases.Thus, depressed levels of antibody-producing capacity prior surgery were important as a causative mechanism of postoperative infections in patients with esophageal cancer. Activation of PMN and monocytes was found as enhanced levels of SOP and cytokine-production in throse with postoperative infections and those measurements seemed to be beneficial as a predictive indicator of high-risk patients for postoperative infections.