Influence of disposable relaparotomy and programmed sanation on the expression and dynamics of clusters determinations on immunocompetent cells of patients with abdominal sepsis caused by severe peritonitis

V Polyovyy,O Dzyubanovsky,I Dzyubanovsky,A Kovalchuk,V Dzhyvak

doi:10.12775/jehs.2021.11.04.016

Abstract

Relaparotomy in the treatment of postoperative complications of abdominal surgery remains a difficult problem of modern surgery.To evaluate the prognostic value of expression clusters of determination on immunocompetent cells of patients, the dynamics of HLA-DR + molecules and cytokines in the blood of patients with abdominal sepsis caused by severe peritonitis, as well as abscesses and phlegmons for postoperative period.Materials and methods.The study was conducted in 40 patients diagnosed with abdominal sepsis in the period from 2017-2020, which was treated in medical institutions of Chernivtsi and Ternopil in Ukraine, and which were divided into control and research groups. The control group consisted of 17 patients without signs of abdominal sepsis and acute surgical pathology. Determination of the expression of determination clusters such as CD11a, CD162, CD95, CD16 on immunocompetent cells, and the study of the dynamics of expression of HLA-DR + molecules and the content of cytokines IL-2, IL-4, IL-6 in the blood of patients was performed in the postoperative period. Both groups were representative by age, sex, comorbidities, risk factors. Determination of experimental parameters in the blood of patients was performed in the postoperative period (the results were evaluated before surgery, on the first, third, seventh, and on the fourteenth day of the postoperative period).Research results and their discussionIn patients with abdominal sepsis caused by severe peritonitis, the expression of HLA-DR + molecules on immunocompetent cells increases, which to some extent indicates an intensification of γ-interferon synthesis. At the same time, there is a sharp decrease in the content of IL-2 in the blood - the main regulator of a specific immune response.

Highlights

Performing relaparotomies in the treatment of postoperative complications of surgical operations on the abdominal organs remains a difficult problem of modern surgery [1]
Materials and methods The study was conducted in 40 patients diagnosed with abdominal sepsis in the period from 2017-2020, which was treated in medical institutions of Chernivtsi and Ternopil in Research results and discussion Studies have shown that in patients with abdominal sepsis caused by severe peritonitis, the level of CD11a + cells in the blood at the time of hospitalization was almost 6 times lower than the control, and the content of CD162 + and CD16 + cells was found, respectively. 2.8 and 2.0 times less than in virtually healthy individuals
In patients with abdominal sepsis caused by severe peritonitis, who died in the early postoperative period on the third day after relaparotomy and rehabilitation of the abdominal cavity, there is a deep violation of adhesive-cooperative intercellular interaction, as evidenced by extremely low levels of expression. cells CD11α +, CD162 + and CD16 +

Summary

Introduction

Performing relaparotomies in the treatment of postoperative complications of surgical operations on the abdominal organs remains a difficult problem of modern surgery [1]. The aim of the work was to evaluate the prognostic value of expression indicators of determination clusters on immunocompetent cells of patients, the dynamics of expression of HLA-DR + molecules and cytokines in the blood of patients with abdominal sepsis caused by severe peritonitis, as well as abscesses and phlegmons to assess the postoperative period. Notes: p - the degree of probability of differences in indicators relative to control; p1 - the degree of probability of differences in indicators relative to the initial level; p2 - the degree of probability of differences relative to the data on the first day after relaparotomy; n - is the number of observations This is evidence of a deep violation of the adhesive-costimulatory interaction of immunocompetent cells in the area of inflammation. A fourfold decrease in the plasma content of interleukin-2 was observed against the background of a 35.6% increase in the concentration of interleukin (IL) 4 and a 3.5-fold increase in the plasma level of IL-6

Groups of patients

Findings

Conclusions