Effect of laparoscopy on the immune system

Surgery induces alterations in local and systemic immune responses. These changes appear to be associated with an increase in postoperative morbidity. Minimally invasive techniques are considered to improve the preservation of immune function compared with open surgery and may therefore be beneficial for patient recovery. As laparoscopic techniques are increasingly used in abdominal surgery, more research has focussed on the immunologic consequences of these techniques. Nevertheless, the changes that occur in response to trauma are still not completely understood. The immunologic benefits of laparoscopic surgery are the most obvious for minor surgical procedures such as cholecystectomy and antireflux surgery. For more complex procedures such as colorectal surgery for cancer, the benefits are not immediately obvious. Although laparoscopic surgery for colorectal malignancies may be associated with higher survival rates and lower recurrence rates because of improved immune function, it has also been related to high incidences of port-site metastases. Reviews in the literature have now shown that incidences of port-site metastases are comparable to incidences of wound metastases after open surgery. However, it will be necessary to wait for the long-term results of randomized, clinical trials to provide further clarification of how immune function is altered after laparoscopic and open surgery for colorectal cancer.     

阿片样物质对免疫功能的影响

疼痛作为一种应激对机体免疫功能有抑制作用,吗啡本身可造成免疫功能抑制,从而吗啡在进行镇痛治疗时,特别对于那些有潜在免疫功能受抑的病人,是一个需慎重考虑的问题,处理好疼痛、镇痛药物、免疫三者之间关系是一个很重要的课题。曲马多作为一种新型的中枢镇痛药物,对机体存在与吗啡不同的免疫调控作用,现就两者对机体免疫功能的影响及其作用机制作一综述     

高乌甲素对患者围术期免疫功能的影响

目的 探讨高乌甲素对患者围术期免疫功能的影响.方法 择期行乳腺癌根治术、椎管狭窄椎板切除减压术、人工股骨头置换术患者各8例,随机分为2组(n=12):对照组(C组)和高乌甲素组(L组).L组麻醉诱导前30 min经30 min静脉输注高乌甲素8 mg,静脉注射恩丹西酮4 mg;C组给予等容量生理盐水.2组采用异丙酚、瑞芬太尼和罗库溴铵进行麻醉诱导和维持.诱导开始后L组持续背景输注0.28 mg/ml高乌甲素2 ml/h.术毕待患者清醒后,L组采用0.28 mg/ml高乌甲素行病人自控镇痛(PCA),背景输注速率2 ml/h,PCA剂量0.5 ml,锁定时间15 min.C组术后镇痛采用按需单次肌肉注射哌替啶50 mg和氟哌利多2.5 mg.于麻醉诱导前30 min(T1)、术毕(T2)、术后24 h(T3)和48 h(T4)时采集外周静脉血样,采用ELISA法测定TNF-α、IL-2、IFN-γ和sIL-6R浓度;采用流式细胞仪测定CD3、CIM、CD8和NK细胞表达,计算CD4/CD8;采用放射免疫法测定IgA、IgM、IgG、C3和C4浓度.结果 与C组比较,L组T2-4时sIL-6R浓度降低,T3-4时INF-α浓度降低,IL-2和IgA浓度升高,T2,3时IgG浓度升高,T3时IgM浓度和CD4/CD8升高(P＜0.05或0.01).结论 高乌甲素可改善患者围术期体液免疫功能,可能与其镇痛和抗炎作用有关.     

Preservation of immune response after laparoscopy

We evaluated the immunologic responses following laparoscopic and open surgery by comparing delayed type hypersensitivity induration size before and after each method of accessing the abdominal cavity. One hundred and thirty-two male Sprague-Dawley rats were sensitized with keyhole limpet hemocyanine (KLH). Animals were challenged with KLH and phytohemaglutanin (PHA) 10 days after sensitization. On day 14 after initial sensitization animals were randomly divided into three groups. Group one served as controls and had no procedure performed, group two underwent peritoneal insufflation with carbon dioxide gas to a pressure of 6–8 mm Hg for one half hour, and rats in group three had a midline laparotomy which was closed after one half hour. Each rat was challenged with KLH immediately and at three days post-operatively. The area of induration in response to each of the challenges was measured with calipers 24 and 48 hours after the challenge. Results of this skin testing showed that the group of animals that underwent laparotomy, despite having normal responses preoperatively, had significantly diminished responses to both KLH and PHA when challenged postoperatively. The insufflated group showed no differences from control animals at any time point examined. We conclude that DTH response in this model is better preserved after laparoscopy than laparotomy.We further conclude that the defect in DTH response is in the effector arm. The question of the clinical significance of these findings is addressed.Presented at the annual meeting of the Society of American Gastro-intestinal Endoscopic Surgeons (SAGES), Nashville, Tennessee, USA, 18–19 April 1994     

生命早期免疫应激对生殖内分泌功能影响的研究现状

近十年,全球内的育龄女性生育率明显降低,免疫应激对生殖功能的影响及其作用机制已经成为研究热点,尤其对青春期的正常启动、生殖激素的分泌有着显著影响。另外,免疫应激可导致卵巢储备功能的下降,以及交配行为的改变等。本文就近年国内外学者在免疫应激模型的建立、对生殖功能影响及其机制的研究进展进行综述,从而进一步阐明和梳理免疫应激所致生殖功能紊乱的病理生理机制,为相关干预措施提供新思路。     

硬膜外注射吗啡对兔和鼠生理和免疫功能的影响

研究用家兔硬膜外腔注射吗啡和大鼠鞘内注射吗啡作为术后镇痛动物模型，结果观察到：家兔硬膜外腔注射吗啡（２ｍｇ／ｋｇ）后，１５分钟内肠蠕动强度即从用药前的１．９７±０．１７降至０．７８±０．０３（Ｐ＜０．０１），９０分钟以后仍呈明显抑制状态（Ｐ＜０．０１），同时呼吸频率也呈明显降低（Ｐ＜０．０１）；大鼠鞘内注射吗啡（４０μｇ）后，虽然脾脏淋巴细胞总数下降不明显（Ｐ＞０．０５），但是，脾脏淋巴细胞转化和白细胞介素－２（ＩＬ－２）诱生水平呈明显下降（Ｐ＜０．０１），细胞免疫功能受到明显抑制。故病人在用吗啡镇痛时不仅应考虑生理功能受抑制，更应注意其免疫功能的下降，以便进行适当保护，增强其抗病能力。     

曲马多对肺癌患者开胸手术围术期免疫功能的影响

目的 探讨曲马多术前应用对肺癌患者开胸手术围术期免疫功能的影响.方法 择期行开胸手术的肺癌患者60例,随机均分为四组,分别在麻醉诱导后使用曲马多1 mg/kg (T组)、恩丹西酮8 mg(O组)、曲马多1 mg/kg+恩丹西酮8 mg(TO组),对照组(C组)不用药.于术前、术毕测定患者血清T淋巴细胞亚群(CD3+、CD4+、CD8+)及NK细胞百分比.结果 四组术毕CD4+细胞显著减低,CD8+细胞显著增高(P＜0.05).T组术毕NK细胞显著增高(P＜0.05),而其它三组明显降低(P＜0.05).结论 肺癌患者使用曲马多更有利于免疫功能的恢复,主要表现为NK细胞百分比增高.     

两种手术方法对复发性胆总管结石患者血液炎症指标和免疫功能的影响

目的分析腹腔镜胆总管探查术(LCBDE)＋胆道镜对复发性胆总管结石患者血液炎症、免疫功能及并发症的影响。 方法选取2015年1月至2019年12月98例复发性胆总管结石患者作为研究对象,数字随机表法分成开腹组(49例)行开腹胆总管探查术(OCBDE)、联合组(49例)行LCBDE＋胆道镜;采用统计软件SPSS22.0处理数据,术中术后各时间指标、炎症指标及免疫功能计量资料用( ±s)表示,行独立t检验;并发症发生率采用卡方检验：以P<0.05为差异有统计学意义。 结果联合组各时间指标均显著低于对照组(t＝10.172、5.858、6.140, P<0.05)。炎症及免疫功能指标：两组患者术后5 d C－反应蛋白(CRP)、肿瘤坏死因子－α(TNF－α)、白细胞介素－8(IL－8)水平均显著升高(P均<0.05),高迁移率族蛋白B1(HMGB1)水平及自然杀伤细胞(NK)、CD3^＋、CD4^＋/CD8^＋均显著降低(P均<0.05);术后5d,联合组CRP、TNF－α、IL－8、HMGB1水平均显著低于开腹组(t＝10.580、8.424、6.811、2.751, P<0.05),NK、CD3^＋、CD4^＋/CD8^＋、均显著高于开腹组(t＝6.116、5.865、3.448,P<0.05)。两组在残石率、并发症总发生率上差异无统计学意义(P>0.05)。 结论相比于OCBDE,LCBDE＋胆道镜可取得良好的取石效果,降低炎症反应、减轻免疫功能抑制,并促进康复效率。     

Effect of prostaglandin E on immune function in multiple animal models

The immunosuppression seen following major trauma and burns has long been attributed in part to prostaglandin E (PGE). This has been due primarily to the demonstration that PGE levels are elevated following burns and that when PGE is added to leukocyte cultures, it impairs multiple types of leukocyte functions. We investigated the effect of a new long-acting PGE derivative, 16,16-dimethyl-PGE, on immune function in multiple animal models. The PGE derivative had no effect on mortality in burn sepsis models but improved mean survival times in an Escherichia coli peritonitis model. The PGE derivative impaired neutrophil migration into burn wounds at lower dosages. In a rat burn model, when PGE was administered parenterally, it failed to impair cell-mediated immunity at any dosage and improved lymphocyte function at certain dosages. These data indicate that PGE may not be as immunosuppressive in in vivo models as it has been shown to be in in vitro models.     

Effect of transfusion on immune function in a traumatized animal model

Blood transfusions repeatedly have been shown to prolong allograft survival, probably by stimulating suppressor T lymphocytes. The effects of transfusions on immune function in traumatized patients has not previously been investigated. We investigated the effects of transfusions on the immune system using a burned rat model. The transfusions were found to have no effect on the white blood cell counts, differential cell count, or neutrophil migration and bactericidal index. Those animals that received transfusion did exhibit impaired cell-mediated immunity and macrophage migration. Blood transfusions seem to increase further the immunosuppression seen with trauma and surgery.     

Effect of exchange transfusion on cell-mediated immune function following thermal injury

We assessed the effect of syngeneic and allogeneic exchange transfusion (XTF) on cell-mediated immunity in a murine burn model. Mice were given a 30% TBSA scald injury and lymphocyte function was monitored with the popliteal lymph node assay for host-versus-graft (HVG) or graft-versus-host (GVH) response. Nonexchanged burned animals exhibited suppression of GVH response on postburn days (PBD) 3 and 8 and suppression of HVG response on PBD 3, 8, 11, and 14. Syngeneic XTF stimulated GVH response on PBD 3, and significantly improved both GVH and HVG response to alloantigens on postburn days 3 and 8 compared to the response of burned controls. Allogeneic XTF significantly improved GVH response on PBD 3 and 8, but did not improve HVG response. Restoration of lymphocyte function in all experimental groups occurred between PBD 14 and 18 and coincided with wound healing.     

早期肠内免疫营养对烫伤小鼠肠道免疫功能的影响

目的 了解早期免疫强化肠内营养对烫伤小鼠肠道免疫功能的影响.方法 选择24只雄性BALB/c小鼠制作20%TBSAⅢ度烫伤模型,采用简单随机法分成2组.每组12只.普通营养组:于伤后2 h开始经口灌喂普通肠内营养剂;免疫营养组:方法同前,在普通营养剂基础上加入谷氨酰胺和精氨酸.2组营养剂糖、脂肪、蛋白质供热比均为82:3:15,热量与氮之比为150:1.每只小鼠营养摄入按732.2 kJ·kg-1·d-1计算,第1天摄入标准量的1/3,第2天摄入标准量的1/2,第3天起摄入全量,每天的计划量分4～6次喂完.2组营养摄入为等氮、等热量、等体积.小鼠连续灌喂7d后处死,取全段小肠.另取10只同品系小鼠作为健康对照组,同法取材.记录肠集合淋巴结细胞总数,通过流式细胞仪检测淋巴结中CD3+、CD4+、CD19+及凋亡细胞变化,双抗体夹心酶联免疫吸附测定法检测肠IgA变化.结果 健康对照组、普通营养组、免疫营养组小鼠肠道淋巴结细胞总数分别为(4.5±0.6)×106、(2.3±0.4)×106、(3.8±0.5)×106个,与健康对照组比较,后2组细胞数明显减少(P＜0.05).但免疫营养组高于普通营养组(P＜0.05);3组小鼠肠道淋巴结CD3+、CD4+、CD19+细胞数比较情况类似于淋巴结细胞总数.健康对照组、普通营养组、免疫营养组淋巴细胞凋亡率分别为(4.8±2.1)%、(12.7±2.4)%、(8.0±1.7)%,与健康对照组比较,后2组小鼠细胞凋亡率明显增加(P＜0.05),但免疫营养组低于普通营养组(P＜0.05).健康对照组、普通营养组、免疫营养组肠IgA水平分别为(42±7)、(35±6)、(38±6)μg/cm,与健康对照组相比,后2组水平明显减低(P＜0.05),但免疫营养组高于普通营养组(P＜0.05).结论 用强化免疫营养剂进行早期肠内营养,可以改善烫伤小鼠肠道免疫功能.     

Effect of blood transfusions on immune function. Part VI. Effect on immunologic response to tumor

Transfusions are reported to increase the incidence of tumor metastasis in clinical studies and primary tumor growth in animal studies. We evaluated the effect of transfusions on immunologic response to primary and metastatic tumors in multiple rat models. One half of the animals were administered lactated Ringer's solution and one half ACI rat blood at the time of tumor challenge. In 80 rats a slow-growing colon tumor was implanted subcutaneously. At 4 months there were no significant differences in tumor size or leukocyte infiltration of the tumor. Similar results were obtained with a rapidly growing colon cancer. Analysis of T-lymphocyte subpopulations in both groups showed no differences. Rats transfused at the time of intravenous challenge with a suspension of 1 x 10(6) tumor cells had a mean survival time of 38.3 +/- 0.8 days and the control group had a mean survival time of 41.1 +/- 0.8 days (p = 0.016). One week after transfusion, natural killer cell lysis of tumor cells at a 100:1 effector/target cell ratio was 18.0% +/- 1.8% in the transfusion group and 23.0% +/- 1.3% in the control group (p = 0.034). In conclusion, transfusions in multiple rat cancer models did not affect primary tumor growth or the host's immunologic response to it but did significantly impair natural killer cell function and survival with tumor metastases.     

Effect of glucan on neutrophil dynamics and immune function in Escherichia coli peritonitis

Previous studies from our laboratory have demonstrated that glucan, a nonspecific immunomodulator, modifies the course of murine Escherichia coli peritonitis. The protective effect of glucan was mediated, in part, by macrophages. In the present study, leukocyte dynamics in the peritoneal cavity and peripheral blood of glucan-treated mice following E. coli challenge was examined. Additional studies examined in vitro bone marrow proliferation, as well as phagocytosis and intracellular killing of E. coli by neutrophils following glucan administration. ICR/HSD mice were injected ip with glucan (150 mg/kg) or dextrose (5% w/v) on Days 5 and 3 prior to ip challenge with 1 X 10(8) E. coli. Glucan increased (P less than 0.05) total peritoneal neutrophil numbers prior to and following septic challenge. Examination of peripheral blood revealed that ip glucan treatment in E. coli peritonitis significantly (P less than 0.001) increased the number of circulating neutrophils. Additionally, neutrophils from glucan-treated mice showed increased phagocytosis of E. coli in vitro. Glucan therapy also increased bone marrow proliferation. We conclude that (1) glucan enhances peritoneal neutrophil levels, (2) peripheral blood neutrophils are increased following glucan and E. coli, (3) ip glucan increases bone marrow proliferation, and (4) neutrophils from glucan-treated mice showed enhanced phagocytosis of E. coli in vitro. Thus, the beneficial effect of glucan is mediated not only by activated macrophages, but also by the neutrophilic leukocyte.     

纵隔充气联合腹腔镜食管癌根治术对患者术后免疫功能的影响

本研究旨在观察纵隔充气联合腹腔镜食管癌根治术对患者术后免疫功能的影响。现报道如下。     

不同手术时间的腹腔镜胆囊切除术对机体应激和免疫功能的影响

目的:研究腹腔镜手术时间对机体应激和免疫功能的影响。方法:选择2002年9月至2003年3月所行腹腔镜胆囊切除术(LC)59例,按手术时间分为3组,手术时间≤30min为A组共16例, 30~60min为B组共26例, >60min为C组共17例。分别测定手术前及手术后第2天应激指标:C 反应蛋白(CRP)、静脉血糖(BG)、白介素- 6 (IL- 6 )、白细胞计数(WBC)、中性粒细胞比例(NEUT)和免疫指标:免疫球蛋白IgA、IgG、IgM、补体C3、C4。结果:不同时间组的腹腔镜胆囊切除术术后各应激和免疫指标之间差异无显著性(P>0. 05)。结论:腹腔镜胆囊切除手术时间对机体应激和免疫功能的影响甚微。     

Cell-mediated immune response is better preserved by laparoscopy than laparotomy

BACKGROUND: This study compares the effects of carbon dioxide pneumoperitoneum versus laparotomy on cellular-mediated immune response in a murine model. METHODS: Sixty-eight female C3H/He mice were sensitized to keyhole limpet hemocyanin (KLH) and to a mouse mammary carcinoma cell line (MC2) before surgery. Animals were randomized into 4 groups: group I, anesthesia (control); group II, pneumoperitoneum with carbon dioxide; group III, extraperitoneal wound; group IV, laparotomy. All animals were challenged subsequently with KLH and MC2 tumor cells. Delayed-type hypersensitivity skin reaction (DTH) to KLH was measured on postoperative days (PODs) 1, 2, 4, and 5. Tumor growth was assessed weekly as an indicator of postoperative cellular immune response. RESULTS: Compared with preoperative values, postoperative DTH skin reactions were significantly less for all PODs in groups III and IV (P < .05), on POD 1 and 4 in group II (P < .05) and POD 4 for group I (P < .05). Group IV showed significantly fewer DTH skin reactions for all PODs compared with groups I and II (P < .05) and all PODs except on day 2 compared with group III (P < .05). Tumor growth was significantly increased at postoperative week 2 (n = 3/17 mice) and 3 (n = 4/17 mice) in group IV, when compared with groups I and II (P < .05). CONCLUSIONS: Cellular immunity is preserved after carbon dioxide pneumoperitoneum compared with extraperitoneal incisions and laparotomy as measured by DTH and the ability to reject an immunogenictumor.     

没食子儿茶素没食子酸酯对中波紫外线抑制树突状细胞免疫功能的保护作用

目的:研究没食子儿茶素没食子酸酯(epigallocatechingallate,EGCG)对紫外线抑制树突状细胞的细胞免疫功能的保护作用。方法:分离外周血单核细胞,用细胞因子诱导树突状细胞(DC)成熟后,使用不同剂量的中波紫外线(UVB)照射,分别将EGCG处理或未处理的DC与T淋巴细胞进行混合培养,72h后用MTT法检测DC刺激T淋巴细胞增殖的能力。结果:UVB以剂量依赖性方式抑制DC刺激自体T淋巴细胞增殖能力,当UVB剂量大于10mJ/cm2时抑制率即可达100%,使用浓度为200μg/mL的EGCG处理DC后,各剂量组UVB所致的免疫抑制作用则可得到部分改善。结论:紫外线可以直接抑制DC的免疫功能,EGCG具有拮抗紫外线抑制DC细胞免疫的功能。