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

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 an...

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Bibliographic Details
Published in:Surgery 1996-03, Vol.119 (3), p.316-325
Main Authors: Decker, Dorothee, Schöndorf, Martin, Bidlingmaier, Frank, Hirner, Andreas, von Ruecker, Alexander A.
Format: Article
Language:English
Subjects:
AIDS/HIV
Biological and medical sciences
Down-Regulation
Female
HLA-DR Antigens - analysis
Humans
Immunity
Interferon-gamma - biosynthesis
Interleukin-4 - biosynthesis
Ki-1 Antigen - analysis
Lymphocyte Count
Male
Medical sciences
Middle Aged
Miscellaneous
Receptors, IgE - analysis
Stress, Physiological - immunology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical Procedures, Operative
Th1 Cells - immunology
Th2 Cells - immunology
Up-Regulation
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Summary: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 (FœRII, 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
ISSN:0039-6060
1532-7361
DOI:10.1016/S0039-6060(96)80118-8