Changes in Humoral and Cellular Immunity in Tertiary Peritonitis

Abstract

The objective of the research was to give a comparative characteristic of parameters of humoral and cellular immunity in the development of secondary and tertiary peritonitis. Materials and methods. The research enrolled 109 patients with secondary peritonitis, 20 of whom developed tertiary peritonitis. Changes in humoral and cellular immunity were evaluated by serial blood tests for the determination of leukocyte count, the relative number of lymphocytes, Ig A, M, and G levels, as well as by counting the phagocytic index, the phagocytic number and the leukocyte intoxication index. The statistical processing of the obtained data was made using the STATISTICA 5.0 software (StatSoft, USA). Results. All the patients were divided into 2 groups: the group of patients with secondary peritonitis (n=89) and the group of patients with tertiary peritonitis (n=20). In the development of tertiary peritonitis, leukocytosis, relative lymphocytopenia and high values of the leukocyte intoxication index persisted during the entire observation period. In tertiary peritonitis, the phagocytic index was significantly lower only on the day of hospitalization. In the group of tertiary peritonitis, the phagocytic number decreased significantly until the 7th day after surgery. Ig A, M and G levels were lower since admission and subsequently decreased as compared to the results in the group of patients with secondary peritonitis. Conclusions. 1. Tertiary peritonitis is the most severe form of abdominal sepsis with high rates of mortality and rather difficult early diagnosis. 2. With the development of tertiary peritonitis, leukocytosis increases and relative lymphocytopenia develops. 3. The reduction in phagocytic index is indicative for the prognosis of tertiary peritonitis. 4. Ig A and M levels are significantly lower, and the leukocyte intoxication index is high at the time of hospitalization in patients who subsequently develop tertiary peritonitis. Problem statement and analysis of the recent researchFor decades, abdominal sepsis remains an actual and still unresolved problem of emergency surgery [1,2]. Present contradictions in the approaches to diagnosis and treatment of its most frequent manifestation -secondary peritonitis (SP) -indicate its special complexity [3,4]. The nature of the immune response, as one of the leading components of the pathogenesis of sepsis, allows the surgeon to evaluate not only the efficacy of treatment, but also to predict the further course of the disease [5,6,7,8]. Nowadays, the patient's immune status in tertiary peritonitis (TP) is not sufficiently studied and requires in-depth analysis, namely from the perspective of prediction of changes in its parameters [9,10].The objective of the research was to give a comparative characteristic of parameters of humoral and cellular immunity in the development of SP and TP.