Паёми Сино (Mar 2018)
IMMUNITY SYSTEM AFTER EXTENDED SURGERIES IN PATIENTS WITH LOCALLY ADVANCED STOMACH CANCER
Abstract
Objective: Examine the influence of splenectomy in patients with locally advanced stomach cancer (LASC) on the immune system and the frequency of postoperative infectious complications. Methods: The system of immunity of 55 patients with LASC is studied before and after an extended gastrectomy with splenectomy. Cellular and humoral immunity were assessed. The immune component cells were determined by means of reactions an indirect rosette using monoclonal antibodies to form rosettes. The phenotype of immunocompetent cells was determined using monoclonal antibodies. To determine B-lymphocytes, erythrocytes coated with antibodies to CD19 antigens specific for B cells as well as HLA-DR antigens found on B-lymphocytes and activated T-cells were used; for natural killers – diagnostics with monoclonal antibody to CD16, as well as CD95 – the factor of apoptosis and CD HLAII. The functional state of the B-systems of immunity was evaluated by determining the serum immunoglobulins of the main classes IgG, IgA, IgM by the method of radial immune diffusion by Mancini. Results: It was found that after gastrectomy with splenectomy, the statistically significant decrease in IgG concentration to 7.2±0.12 g/l and IgM to 0.6±0.02 g/l and increase in leukocyte-T-lymphocyte index to 23.0±0.54 units. Before and after the performed operation, significant differences were found in such indicators as CD4, CD16, CD19, CD4/CD8. When studying the parameters of apoptosis and the characteristics of expression of CD95 molecules on peripheral blood lymphocytes, no significant changes in the activation rates of peripheral blood lymphocytes were revealed. It is established that in the splenectomy group complications associated with impaired immune status develop. This was manifested by a tendency to frequent colds, detected in 41.2% of patients due to involvement of the lungs and bronchi in the pathological process, and 11.8% of the patients had a predisposition to pustular skin diseases. Conclusion: Splenectomy leads to changes in both the humoral and cellular links of the immune status, as well as the nonspecific resistance of the organism of the patients with LASC. These changes in laboratory indicators are clinically manifested by the propensity to infectious diseases.
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