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KMID : 0371319940460040615
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Journal of the Korean Surgical Society
1994 Volume.46 No. 4 p.615 ~ p.628
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Serum Tumor Necrosis Factor, Interleukin-1, Interleukin-6 and Neopterin in Critically III Surgical Patients
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Abstract
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Surgical injury and infection stimulate the production of a variety of endogenous mediators. These mediators in turn, initiate immune. hematologic and metabolic alterations that are integral to the reponse of the host to injury. Of these,
monokines
such
as TNF, IL-1, IL-6 are most important endogenous mediators of this host response. Monokines have beneficial properties in injury, such as the stimulation of antimicrobial function, healing of wounds, myelostimulation and mobilization of substrate
stores. an exaggerated or prolonged secretion of these proteins may be detrimental for the host. Specifically, aberrant secretion of monkines are thought to be responsible, in part, for the changes in the host during septic shock and in the
cachexia of
chronic disease.
This study was undertaken to investigate the possible role of monokines in the pathogenesis of critical surgical illness.
Levels of serum TNF, IL-1, IL-6 and neopterin, an index of macrophage activation, were measured in 29 surgical intensive care patients.
TNF was detectable in 69.2 per cent of the patients with sepsis versus 31.3 per cent of those without sepsis, in 72.7 per cent of the patients who died versus only 33.3 per cent of the survivors and in only two healthy normal controls. The
frequency of
the appearance of TNF correlated with both infection and mortality.
Levels of serum IL-1 in critically ill surgical patients were significantly higher than those of healthy controls. Serum concentrations of IL-1 were markedly elevated in patients with septic complications. And serum IL-1 levels were higher in
critically
ill patients who subsequently died tan in those who survived.
Serum IL-6 levels in patients with septic complications were significantly higher than those without septic complication.
Patients with fatal outcome always showed a higher IL-6 levels than those of survivors. Levels of serum neopterin were also significantly increased in critically ill patients compared with controls and this increase was related to the sepsis or
fatal
outcome.
Patients with fatal outcome showed significantly higher concentration of serum neopterin than those of survivors.
These data indicate that TNF, IL-1, IL-6 and neopterin might be useful parameters for the monitoring of the clinical course in critically ill patients. Moreover, they might indicate the possible central role of macrophage activation in the
development
of critical surgical illness.
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KEYWORD
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