Imunomodulacijski utjecaj opće i regionalne anestezije na serumsku razinu proupalnih i protuupalnih citokina [Immunomodulation effect of spinal and general anaesthesia on serum concentration of pro-inflammatory and anti-inflammatory cytokines]

Žura, Marijana (2012) Imunomodulacijski utjecaj opće i regionalne anestezije na serumsku razinu proupalnih i protuupalnih citokina [Immunomodulation effect of spinal and general anaesthesia on serum concentration of pro-inflammatory and anti-inflammatory cytokines]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Surgery induces release of neuroendocrine hormones, cytokines and acute phase proteins. The aim of this study was to assess the effect of spinal and general anaesthesia on serum concentration of pro-inflammatory (interleukin-1α (IL-1α), interleukin-1β (IL-1β), Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), MCP-1 (Monocyte chemoattractant protein–1), VEGF (Vascular endothelial growth factor), EGF (Epidermal growth factor), antiinflammatory cytokines (interleukin-4 (IL-4), interleukin-10 (IL-10) and cytokines which are secreted by Th1 helper lymphocytes (interleukin-2 (IL-2), interferon-γ (IFN-γ). 40 patients with American Society of Anesthesiologists status I and II who were scheduled for Transurethral Resection of the Prostatae were anesthetized in spinal or general anesthesia. Peripheral venous blood samples were collected 2 hours before surgery on the first, third and fifth postoperative days. We measured pro-inflammatory cytokines, anti-inflammatory cytokines and cytokines which are secreted by Th1 helper lymphocytes in order to establish differences in patients before and after surgery. Statistically significant differences were found in serum levels of interleukin-2 (IL-2) between general and spinal anesthesia (p=0.043). The concentration of IL-2 was continously elevated in general anesthesia, but not in spinal anesthesia. There was also statistically significant increase of interleukin-6 (IL-6) in spinal (p=0.043) and general anesthesia (p=0.03) in comparison to preoperative value. Surgery-related postoperative release of the pro-inflammatory cytokine IL-6 was increased in patients after spinal and general anesthesia. In our study, increased levels of IL-2 were found in patients anesthetized by general anesthesia compared to spinal anesthesia. Serum concentrations of other pro-inflammatory cytokines, anti-inflammatory cytokines and cytokines which are secreted by Th1 helper lymphocytes showed no statistical difference before and after surgery under general and spinal anesthesia.

Abstract in Croatian

Kirurški zahvat potiče oslobađanje neuroendokrinih hormona, citokina i proteina akutne faze. Cilj ove studije bio je procjeniti utjecaj spinalne i opće anestezije na serumsku razinu proupalnih (interleukin-1α (IL-1α), interleukin-1β (IL-1β), Čimbenik tumorske nekroze-α (TNF-α), interleukin- 6 (IL-6), interleukin-8 (IL-8), Monocitni kemotaksijski protein–1 (MCP-1), Čimbenik rasta krvožilnog endotela (VEGF), Epidermalni čimbenik rasta (EGF), protuupalnih citokina (interleukin-4 (IL-4), interleukin-10 (IL-10)) i citokina koje izlučuju pomoćnički Th1 limfociti (interleukin-2 (IL-2), interferon-γ (IFN-γ)). 40 pacijenata koji su bili klasa I ili II prema Američkom uduženju anesteziologa i predviđeni za transuretralnu resekciju prostate anestezirani su spinalnom ili općom anestezijom. Uzorci periferne venske krvi uzeti su dva sata prije operativnog zahvata, prvi, treći i peti postoperativni dan. Iz uzoraka krvi odredile su se vrijednosti proupalnih, protuupalnih i citokina koje izlučuju pomoćnički Th1 limfociti u cilju određivanja razlike prije i poslije operativnog zahvata. Statistički značajna razlika uočena je u serumskim vrijednostima interleukina-2 (IL-2) između spinalne i opće anestezije (p=0.043). Koncentracija IL-2 stalno je povišena u općoj, ali ne i spinalnoj anesteziji. Prisutno je i statistički značajno povećanje interleukina-6 (IL-6) u spinalnoj (p=0.043) i općoj anesteziji (p=0.03) uspoređujući sa preoperativnom vrijednošću. Kirurškim zahvatom uvjetovano postoperativno stvaranje proupalnog citokina IL-6 je povećano u spinalnoj i općoj anesteziji. U našem istraživanju, povišene vrijednosti IL-2 pronađene su kod pacijenata anesteziranih u općoj anesteziji u usporedbi s spinalnom anestezijom. Serumske vrijednosti drugih proupalnih, protuupalnih i citokina koje izlučuju pomoćnički Th1 limfociti nisu pokazale statistički značajnu razliku prije i poslije operativnog zahvata u grupi spinalne i opće anestezije.

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