Prognostic value of cell-mediated immunity changes in patients with diabetes mellitus and metabolic syndrome undergoing simultaneous surgical operations

Aim. To study the prognostic value of cell-mediated immunity changes in patients with type II diabetes mellitus undergoing simultaneous operations for treatment of cholelithiasis and postoperative ventral hernias. Methods. Two groups of female patients with cholelithiasis and postoperative ventral hernias who underwent planned simultaneous surgical treatment were examined. The firs group included 48 patients with type II diabetes mellitus and abdominal obesity. The second group included 48 patients without diabetes mellitus and metabolic syndrome. Mononuclear leukocytes of peripheral blood were isolated by density gradient centrifugation on Ficoll-verografin. Relative and absolute number of lymphocyte populations and subpopulations and FAS-receptor expression were studied by indirect immunofluorescence using specific monoclonal antibodies. Apoptotic cells were determined by fluorescent microscopy after exposure of separated mononuclear leukocytes to DNA dye Hoechst 33342. Results. Patients with type II diabetes mellitus had higher incidence of purulent complications after laparoscopic cholecystectomy and surgical treatment of ventral hernias (14.6% vs. 2.0%, p <0.01), which was associated with absolute and relative decrease of CD4+ and CD16+ lymphocyte levels and immunoregulatory index and increased spontaneous and FAS-induced apoptosis of mononuclear leukocytes. In patients who developed purulent complications, more significant reduction of the absolute number of CD16+ lymphocytes (34.5±3.8×106/L vs. 76.72±5.16×106/L, p <0.01) and increased spontaneous apoptosis (7.9%±1.1% vs. 2.7±0.3% compared to patients without complications, p <0.01) was determined. Conclusion. Immunological predictors for developing postoperative purulent complications after simultaneous abdominal surgeries in patients with type II diabetes include decreased indicators of spontaneous apoptosis and decreased number of NK-cells.

cholelithiasis, postoperative ventral hernia, type II diabetes mellitus, metabolic syndrome, apoptosis, cell-mediated immunity