Changes in TH1/TH2 immunity after endovascular and conventional infrarenal aortic aneurysm repair: its relevance for clinical practice.
OBJECTIVE
to evaluate local surgical trauma induced by endovascular (TPEG) and conventional infrarenal aortic aneurysm repair (AAA-C), the inflammatory response and changes in cell-mediated and antibody-mediated immunity as illustrated by the type-1/type-2 T-helper (TH1/TH2) cell balance were investigated.


METHODS
prospective study.


METHODS
sixteen patients were included, eight patients underwent AAA-C and eight TPEG. Venous peripheral blood samples were collected 24h preoperatively and 24, 48, 72h, 5 and 7 days postoperatively. Besides the WBC, intracellular TH1/TH2 cytokines (IFN-gamma/IL-4) and the cell surface markers HLA-DR on monocytes and CD23 on B cells were measured by four colour flow cytometry.


RESULTS
statistically significant higher values in the AAA-C group were demonstrated for neutrophiles. The TH1/TH2 immunobalance (expressed by forming the ratio of IFN-(gamma/IL-4 producing T cells as well as by the ratio of HLA-DR(pos) monocytes/CD23(pos) B-cells) showed a significant shift towards TH2 immunity in the AAA-C group whereas TPEG led to a significant lesser shift 24-72h after surgery (p < 0.05).


CONCLUSIONS
TPEG leads to a minor distortion of the TH1/TH2 immunobalance. This implies that TPEG is a less stressing procedure, that is especially beneficial in patients whose conditions are considered less suitable for AAA-C due to age and serious comorbidity.
Decker
D
D
Department of General, Visceral, Thoracic and Vascular Surgery, University Clinic of Bonn, Germany.
Springer
W
W
Decker
P
P
Tolba
R
R
Remig
J
J
Strunk
H
H
Hirner
A
A
von Ruecker
A
A
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000276:immunology* / Q000601:surgery*; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D007111:Immunity, Cellular / Q000502:physiology; D007371:Interferon-gamma / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000502:physiology; D011446:Prospective Studies; D017455:Receptors, IgE / Q000032:analysis; D018417:Th1 Cells / Q000276:immunology*; D018418:Th2 Cells / Q000276:immunology*; D014656:Vascular Surgical Procedures / Q000379:methods*
D006684:HLA-DR Antigens; D017455:Receptors, IgE; D015847:Interleukin-4; D007371:Interferon-gamma