Dynamics of cytokines in patients with enteral insufficiency in advanced peritonitis

Abstract

In this work, changes in the cytokine profile in patients with common forms of peritonitis with enteral insufficiency were studied. The obtained results were compared in patients who survived after surgery and programmed peritoneal sanation and patients who died in the early postoperative period. The aim of the study was to investigate the dynamics of cytokine profile of patients with common forms of peritonitis complicated by enteral insufficiency in order to determine their prognostic value. Material and methods. The object of the study was the blood of 23 patients with common forms of peritonitis and 17 healthy volunteers. To assess the condition of patients performed a dynamic determination in a comprehensive examination of laboratory markers of endogenous toxemia and systemic inflammatory response syndrome: immunological changes in patients by examining blood cells expressing clusters of CD11a+, CD162+, CD95+, CD16+, and molecules of the main histocompatibility complex HLA-DR+ and the level of interleukins IL-2, IL-4, IL-6. Results. During the study in patients with widespread peritonitis complicated by enteral insufficiency, at the time of hospitalization, there was a six-fold decrease in blood levels of CD11a+ cells and the content of CD162+ and CD16+ cells, respectively, 2,8 and 2 times, compared with healthy people. It has been shown that a single remediation programmed relaparotomy within two weeks effectively corrects these changes except for expression on CD16+ cells, which indicates a low effect of this type of surgery on the elimination of immune complexes. It was found that the concentration in plasma IL-2 increased 5 times and was 27,1% higher than that in almost healthy individuals. At the same time, the level of IL-4 in the blood decreased sharply – 4 times. Plasma IL-6 content also reduced. One week after relaparotomy, the expression of HLA-DR + molecules on immunocompetent cells increased again and was 1,8 times higher than the control parameters. In addition, the content of cytokines in the blood plasma increased sharply: the level of IL-2 exceeded the control by 2,4 times, IL-4 by 4 times, and IL-6 by 2 times. Conclusions. 1. Progressive and noticeable decrease in IL-2 content occurs in patients with widespread peritonitis complicated by enteral insufficiency in the complete absence of IL-4 in the blood on the background of a permanent and significant increase in plasma concentrations of IL-6. 2. Under conditions of suppression of the immune response, due to intoxication of the patient's body, the mechanism of endogenous inhibition of the immune response "IL-6 – corticoliberin – corticotropin – corticosteroids" is additionally realized.

Enteric Insufficiency Syndrome in Surgical Patients: Objective Reality or a Symptom of the Disease?

“…Найважливішим серед яких є кислотність шлункового соку, бактеріальна сапрофітна взаємодія, місцеві й загальні імунні порушення та наявність/відсутність безперервної пропульсивної перистальтики ТК. Серед імунних факторів, на думку більшості авторів, важлива роль у підтримці сталості екосистеми ТК належить SJgA кишкового вмісту [43]. Найбільш значне пригнічення як клітинного, так і гуморального імунітету при СЕН відзначається на 4-7 добу післяопераційного періоду.…”