The Clinical Experimental Research On Immunological Alterations In The Patients With Surgical Disease

The Clinical Experimental Research on Immunological Alterations in The Patients with Surgical DiseaseIn order to investigate the effect of surgical disorder to the patient's immunological defense, 25 patients undergone surgical procedure were selected into this clinical trial in which 14 males and 11 females, 18 to 85 years old, mean age 58.68+10.05, were enrolled. According to the APACHE II score system, all patients were divided into 2 subgroups on admission day that were mild group (APACHE IKS; age 58+8.996) and severe group (APACHE >8; age 59.89 + 24.44). Monocyte surface antigens CD14 and HLA-DR were determined with flow cytometry, which were isolated from patient's peripheral blood withdrawn on pre-operative day and post-operative days 1, 3, and 7 (POD1, PODS, AND POD7) followed by calibrating the percentages of CD14+ cell and HLA-DR+ cell. 10 healthy adults, in same age distribution, were selected as normal control, whose peripheral blood was tested in same way. APACHE IIscore and post-operative recovery were dynamically reviewed. The correlations between percentages of CD14+ and HLA-DR+ cell as well as APACHE II score were analyzed. The application of APACHE II score system in evaluation of surgical diseases and their immunological defense effect were individually studied. Results 1 APACHE II: APACHE II score increased companieying with disease worse progressing. The significance was found in mild group on different time, but no difference in severe group. APACHE II score was significantly higher in severe group than that in mild . 2 Percentage of CD14+ Monocyte: There was not any significant difference in mild group between different time points, in contrast significant difference was found in severe group. No significant difference was determined between pre-operative points in mild and severe groups compared with normal control. Post-operative CD14+ Monocyte percentage was significant higher than that in mild group on the same time point and normal control. 3 Percentage of HLA-DR* Monocyte: The percentage of HLA-DR+ cell in severe group pre-operatively appeared significant higher thanthat in normal control, but no significant difference between mild and normal control groups. HLA-DR+ percentage was immediately lower followed by its increasing tendency, meanwhile it in severe group presented consistent lower. In mild and severe groups post-operative HLA-DR+ percentage were significant lower compared with pre-operative status, and appeared significant lower in severe group than in mild group. 4 Correlation analysis: APACHE II score generally had inverse correlation with CD14+ and HLA-DR+ percentages. CD14+ was correlative with HLA-DR+. Conclusion: 1 APACHE II score is very correlative with disease severity. Continual and dynamic using APACHE II score system to monitor disease progression can in time, accurately and objectively evaluate patient status. 2 CD14+ percentage is going lower with the disease progressing to severe and the patient immunological function is inhibited. Acute surgical procedure performed on the patient whose immune system is under stress condition is a main reason leading to post-operative immunological dysfunction. 3 Lower HLA-DR* percentage reflects the impairing of monocyte specificimmune response and the immune system has been inhibited in patient body. The continuous decreasing of HLA-DR expression with severing disease and complication occuring suggests patient's worse progression. 4 CD14 and HLA-DR antigen expression on Monocyte have the uniformity to reflect Monocyte immune function. The impaired Monocyte immune function with severer disorder and higher APACH II score can lead to human body immuno-dysfunction and more complications.