0.37 THE SERUM INTERLEURIN 6 (IL-6)RESPONSETO ELECTIVESURGERY. A Shenkin,W D Fraser, J D Series, H J G Burns, J Van Damne, Departments of Biochemistry and Surgery,Glasgow Royal Infirmaryand Rega Institute, Leuven. IL-6 (B cell stimulatingfactor 2, interferon62) is a cytokinewhich may be involved in the control of the acute phase protein responseto trauma. The kineticsof IL-~ release in relationto acute phase proteinshas not been established. We have investigated changes in serum IL-6 followingcholecystectomy (6 patients)and resection of colonic neoplasm (5 patients). Multiplevenous blood sampleswere taken before, during and after operation. Serum was analysed for IL-6 by hybridomagrowth stimulation assay using purified IL-6 as standard. 1 unit IL-6 produceshalf maximal stimulation and is approximately 1 pg. C-reactiveprotein (CRP) was measuredby fluorescence polarisation. Plasma was also analysed for IL-1 by a two cell bioassay (LBRM/HTzA) and for tumour necrosis factor (TNF) by L929 cytolysisassay. Serum IL-6 increasedin all patientswithin 1 hour of incision,reachinga maximum between 2-4 hours after incisionfor cholecystectomy (median58 U/ml: range 23-110U/ml) and between 4-8 hours after incisionfor colorectalsurgery (median80 U/ml; range 4O- 290 U/ml) (not significant: Mann-Whitney Test). The maximum IL-6 correlated with length of operation (cholecystectomy r=0.75; colonicresectionr=0.93; overall r=0.76). Serum CRP was detectable (>lO nq/l) by 8-12 hours of incision , maximum concentrations berng reachedby 36-48 hours in both groups. Maximum serum CRP did not correlatewith maximum serum IL-6 concentration or length of operation. There was no consistentincrease in plasma IL-1 or TNF followingsurgery,although some pre- and post-operation samples had detectableIL-l. We conclude that serum IL-6 increasesrapidly followingelectivesurgery, that this may be related to the magnitudeof the surgery, and this precedes the rise in serum acute phase proteins. 0.38 THE POST OPERATIVE ACUTE PHASE RESPONSE IS UNINFLUENCED BY NUTRITIONAL STATUS. A T Boyd, G A Young, M J McMahon, University Department of Surgery, The General Infirmary, Leeds, UK. The acute phase response is attenuated by protein deprivation in experimental animals and total hepatic protein synthesis is reduced in patients who have lost weight. It has been suggested, however, that acute phase protein synthesis in man is independent of nutritional status. . To assess the effect of nutritional status on the magnitude of the postoperative acute phase plasma protein response we studied C-reactive protein (CRP), an acute phase reactant whose plasma level usually peaks approximately 48 hours after the initiating stimulus. Plasma levels were measured, by laser nephalometry, daily for 3 days after radical resection for gastro-oesophageal cancer. Twenty eight patients were studied. No significant correlations were found, using Spearman's rank order correlation coefficient, between peak (48hr) plasma CRP and age (r = -0.28, p = 0.08), weight (r = 0.34, p = 0.09), weight loss (r = -0.39, p = 0.70), mid arm circumference (r = 0.36, p = 0.06), triceps skinfold thickness (r = 0.18, p = 0.39), duration of operation (r = 0.25, p = P ?O), or preoperative albumin (r = 0.14, p = 0.48). When divided into two groups on the basis of weight loss (<7.5%, n=17; >7.5%, n = ll), there was no difference between 48hr plasma CRP in the two groups (median 13.4 v 13.5 mg/dl, Mann-Whitney U test). This data suggests that acute phase protein synthesis in response to a major operation is preferentially maintained during malnutrition at the expense of albumin and other transport proteins. 29

The post operative acute phase response is uninfluenced by nutritional status

Download PDF Report

Upload
lelien
View
213
Download
0

Embed Size (px)

Citation preview

Page 1: The post operative acute phase response is uninfluenced by nutritional status

IL-6 (B cell stimulating factor 2, interferon 62) is a cytokine which may be involved in the control of the acute phase protein response to trauma. The kinetics of IL-~ release in relation to acute phase proteins has not been established. We have investigated changes in serum IL-6 following cholecystectomy (6 patients) and resection of colonic neoplasm (5 patients).

Multiple venous blood samples were taken before, during and after operation. Serum was analysed for IL-6 by hybridoma growth stimulation assay using purified IL-6 as standard. 1 unit IL-6 produces half maximal stimulation and is approximately 1 pg. C-reactive protein (CRP) was measured by fluorescence polarisation. Plasma was also analysed for IL-1 by a two cell bioassay (LBRM/HTzA) and for tumour necrosis factor (TNF) by L929 cytolysis assay.

Serum IL-6 increased in all patients within 1 hour of incision, reaching a maximum between 2-4 hours after incision for cholecystectomy (median 58 U/ml: range 23-110 U/ml) and between 4-8 hours after incision for colorectal surgery (median 80 U/ml; range 4O- 290 U/ml) (not significant: Mann-Whitney Test). The maximum IL-6 correlated with length of operation (cholecystectomy r=0.75; colonic resection r=0.93; overall r=0.76).

Serum CRP was detectable (>lO nq/l) by 8-12 hours of incision , maximum concentrations berng reached by 36-48 hours in both groups. Maximum serum CRP did not correlate with maximum serum IL-6 concentration or length of operation.

There was no consistent increase in plasma IL-1 or TNF following surgery, although some pre- and post-operation samples had detectable IL-l.

We conclude that serum IL-6 increases rapidly following elective surgery, that this may be related to the magnitude of the surgery, and this precedes the rise in serum acute phase proteins.

0.38 THE POST OPERATIVE ACUTE PHASE RESPONSE IS UNINFLUENCED BY NUTRITIONAL STATUS. A T Boyd, G A Young, M J McMahon, University Department of Surgery, The General Infirmary, Leeds, UK.

The acute phase response is attenuated by protein deprivation in experimental animals and total hepatic protein synthesis is reduced in patients who have lost weight. It has been suggested, however, that acute phase protein synthesis in man is independent of nutritional status. .

To assess the effect of nutritional status on the magnitude of the postoperative acute phase plasma protein response we studied C-reactive protein (CRP), an acute phase reactant whose plasma level usually peaks approximately 48 hours after the initiating stimulus. Plasma levels were measured, by laser nephalometry, daily for 3 days after radical resection for gastro-oesophageal cancer.

Twenty eight patients were studied. No significant correlations were found, using Spearman's rank order correlation coefficient, between peak (48hr) plasma CRP and age (r = -0.28, p = 0.08), weight (r = 0.34, p = 0.09), weight loss (r = -0.39, p = 0.70), mid arm circumference (r = 0.36, p = 0.06), triceps skinfold thickness (r = 0.18, p = 0.39), duration of operation (r = 0.25, p = P ?O), or preoperative albumin (r = 0.14, p = 0.48).

When divided into two groups on the basis of weight loss (<7.5%, n=17; >7.5%, n = ll), there was no difference between 48hr plasma CRP in the two groups (median 13.4 v 13.5 mg/dl, Mann-Whitney U test).

This data suggests that acute phase protein synthesis in response to a major operation is preferentially maintained during malnutrition at the expense of albumin and other transport proteins.