The Effect Of Classical Intrafascial Supracervical Hysterectomy On IL-10,T Lymphocyte Subsets And Expression Of Human Leukocyte Antigen-DR On Monocytes In Peripheral Blood

Along with the continuous development of laparoscopic technic and the renewal of the instrument equipments, laparoscopy occupies the more and more important position in the diagnosis and treatment of the gynecologic diseases. Classical intrafascial supracervical hysterectomy(CISH) is a typical model of the appliance of laparoscopy in gynecology. Currently the report on the effect of CISH on immune function has not been seen.Cytokine is indispensable to leading inflammatory responses to the wound. Interleukin 10(IL-10) is a kind of new potent anti-inflammatory and immunosuppressor cytokine. The mainly function of IL-10 is to suppress antigen presentation of monocytes,and to suppress production of the Th1 cytokine. The T lymphocyte is a kind of important immune cell, which mediate cell-mediated immunity. T cells play an important role during anti-infection. The change of peripheral T lymphocyte subsets can show the immune function. Moreover,the monocyte-macrophages also play an important role in the recognition and processing of foreign antigen. The human leucocyte antigen DR(HLA-DR) which belongs to the major histocompatibility complex(MHC) â…¡ molecule, expressed mainly on the suface of the monocyte-macrophage, is critical in the process of presenting antigens to T lymphocytes by monocyte-macrophages. The level of expression of HLA-DR on monocytes can show the immune function. Currentlythe research of the effect on expression of HLA-DR on monocytes after laparoscopy is popular in the world, but has not yet been reported in our country.Objective This research was designed to evaluate the effect of laparoscopic and abdominal hysterectomy on immune function. Interleukin 10(IL-10) in peripheral blood were measured by enzyme-linked immunosorbent assay(ELISA) .T lymphocyte subsets and the expression of human leukocyte antigen-DR (HLA-DR) on peripheral blood monocytes were measured by the cytofluorimetric method. And then Operation time, bleed amount in operation were compared between the two operations, in order to further study the value of laparoscopy in gynecology, and then provide theoretical foundation of laparoscopic application to the malignant tumor and infection sufferer.Materials and Methods(1). All subjects were divided into two groups: ?the CISH group(n=32): we chose 32 patients who suffered from gynaecol benign diseases and had hysterectomy signs and admitted to the Third Affiliated Hospital of ZhengZhou University between April 2004 and October 2004,including 22 uterine myoma, 10 adenomyosis, these patients underwent CISH.? the abdominal hysterectomy (AH) group(n=28):28 patients undergoing AH who had simlar condition at the same time. This study excluded those patients who had metabolic ,endocrine, heart, hepatic,lung,or renal diseases and taking drugs for these problems,as the drugs might affect the immune function.(2) Preparations before operations: ?All patients must accept gynecologic examination and B ultrasound before operation,their uteri were smaller than the 14 weeks pregnancy uterus. Another diseases were not founded in their pelvic cavity. (2) All cases must regularly accept the cervical cytology assay, excluding cervical cancer.(3)The patients who had irregularly uterine bleeding must accept examination to exclude the malignant diseases.(3) Anesthesia and surgery: General anesthesia was the same in both groups. Patients divided to abdominal hysterectomy underwent a tranverse incision which is the length of 6-8 cm on the lower belly, according to the regular operation approach. CISH was carried out in a standardized technique using 3 trocars and pneumoperitoneum of 13 mmHg. Operation time, bleed amount in operation, postoperative exhausting time andpostoperative morbidity were recorded . All operations were performed by the same surgical team.(4) Peripheral venous blood samples (5 ml) were taken from all patients at 7 o'clock on the day before operation and 1, 4 days after operation. IL-10 were determined by enzyme-linked immunosorbent assay (ELISA). T lymphocyte subsets and the expression of human leukocyte antigen-DR (HLA-DR) in peripheral blood monocytes were measured by the cytofluorimetric method.(5) All experimental data were analyzed using Chi-square test and ANONA or Nonparmetric test and t( t') student test and processed by SPSS11.5. There was a statistical significance when P<0.05.Results1.There was no significant difference between CISH group and AH group in mean ages, weights ,the size of uterus and the types of diseases, operation time (P>0.05) . Compared with AH group, CISH group had less operation bleeding (P<0.05 ).2 . There was no significant difference between CISH group and AH group in IL-10,T lymphocyte subsets and the expression of human leukocyte antigen-DR (HLA-DR) in peripheral blood monocytes (P>0.05) .3. The level of IL-10 increased significantly in AH group (P< 0.05) but not in CISH group (P>0.05) on 1,4 days after operation .There was significant difference between two groups (P<0.05). 4. Postoperative level of CD3\ CD4\ CD4+/CD8+T lymphocyte decreased significantly on day 1 after operation in CISH group (P< 0.05), increased to the preoperative values On day 4 after operation(P>0.05); it also decreased significantly on day 1 after operation in AH group (P< 0.05), increased slightly On day4 but still significantly lower than preoperative values(P< 0.05), and there were statistical significance between two groups (P< 0.05). Postoperative level of CD8+ T lymphocyte did not change significantly in two groups (P>0.05) .5. Monocyte HLA-DR expression decreased markedly on day 1 after operation in both CISH and AH groups(P< 0.05), there was no significant difference between two groups (P>0.05).On day 4, HLA-DR expression increased in both groups, but there was marked difference between two groups(P<0.05).Conclusions1. The level of IL-10 increased significantly in AH group ,but not in CISH group. It is also said that CISH has less effect on immune function.2. The counts of CD3,CD4 decreased and CD4/CD8 ratio lowered after both CISH and AH.The extent of decrease was less significangly after CISH than AH, showing that CISH has less effect on immune function than AH.3. Both CISH and AH could cause HLA-DRexpression on peripheral blood mononuclear cells to decrease., which more rapidly return to normal level after CISH. It shows CISH has less effect on immune function than AH.