Immunological status of patients with obstructive jaundice and immunostimulatory effect of arginine.

Sepsis is a major factor in the high mortality and morbidity following diagnostic and therapeutic procedures in patients with obstructive jaundice. The reasons for this increased susceptibility to infection are not fully understood. We therefore observed prospectively changes in immunological status of patients with obstructive jaundice in the perioperative period and studied immunological effects of perioperative arginine therapy. The results showed that there was a significant reduction in interleukin 2 (IL-2) production, interleukin 2 receptor (IL-2R) expression and lymphocyte response to phytohemagglutinin (PHA) mitogen in patients with obstructive jaundice compared with normal controls. After operation, the immune suppression in patients with obstructive jaundice was more significant. Arginine is a known T lymphocyte stimulator. Perioperative supplement with arginine significantly enhanced the immune function of patients with obstructive jaundice, the mechanism being related to increased IL-2 production and IL-2R expression.

Alternation of monocyte function in patients with obstructive jaundice.

Patients with obstructive jaundice have a high susceptibility to infection in the process of treatment and the reason for this is not fully understood. It was postulated that it may bear some relations to abnormalities of immune function. In this article, 28 cases of obstructive jaundice were selected to investigate alternation of monocyte immune function with the purpose of exploring mechanism of high susceptibility to infection from the perspective of immunology. The results showed that interleukin 1 production by monocytes significantly decreased and prostaglandin E2 increased, HLA-DR expression of monocytes was remarkably depressed. HLA-DR expression of monocytes was further decreased with recovery slower than non-jaundiced patients after operation. All this may be responsible for high susceptibility to infection in the process of treatment of obstructive jaundice.

Effect of arginine on immune function in rats with obstructive jaundice.

In this study we used an experimental model produced by bile duct ligation (BDL) in rats to demonstrate relation between immune function and susceptibility to infection associated with obstructive jaundice and immunoregulatory effect of arginine in BDL rats. Our experimental results showed that thymus weight, content of lymphocytes in thymus and responsiveness to Con A in vitro were dramatically reduced in BDL rats as compared to rats with sham operation and that the impairment of lymphocyte function was significantly related to the susceptibility to infection. Arginine, as a T cell stimulator, markedly improved immune function and decreased susceptibility to infection of BDL rats.

Effects of surgical trauma on interleukin 2 production and interleukin 2 receptor expression.

To elucidate the mechanism of immunologic abnormalities induced by surgical trauma, we measured interleukin 2 (IL-2) production and IL-2 receptor expression in peripheral blood mononuclear cells from 16 patients with cholelithiasis. Compared with preoperative levels, IL-2 production and IL-2 receptor expression were significantly reduced on postoperative day 4, and the reduction was consistent with the suppression of lymphocyte proliferative response to phytohemagglutinin.

Altered lymphocyte subsets and natural killer cells of patients with obstructive jaundice in perioperative period.

Sepsis is a common and occasionally lethal complication of obstructive jaundice. The reasons for the increased susceptibility to infection are not fully understood. This study was conducted to examine lymphocyte subsets and natural killer cells of patients with obstructive jaundice in perioperative period. In these patients, when compared with normal controls, there was a significant reduction in the percentage of Leu 4 (pan T lymphocytes), Leu 3a (T helper cells) and Leu 7 (natural killer cells) before operation, and the immune suppression induced by surgical operation was more marked and persistent.

Interleukin 2 production and its relationship with T lymphocyte subsets in patients with obstructive jaundice.

Sepsis remains a major risk in the high mortality and morbidity after surgery for obstructive jaundice. The reasons for the increased susceptibility to infection are unknown. This study examined interleukin 2 (IL-2) production and the lymphocyte response to PHA mitogen in 31 patients with obstructive jaundice. Among them, 18 patients were simultaneously investigated by enumeration of T lymphocyte subsets in peripheral blood with APAAP technique. The results showed that the patients had significantly decreased IL-2 production and lymphocyte response to PHA mitogen. The percentage of Leu 3a (helper/inducer T cell) in the patients was significantly lower than that in normal controls. Leu 3a/Leu 2a (suppressor/cytotoxic T cell) ratio was significantly lower in these patients. The reduction of IL-2 production correlated significantly with the suppression of lymphocyte proliferation but not with the percentage of Leu 3a cells. From these results, it may be suggested that the reduction of IL-2 production in the patients with obstructive jaundice is an important reason for the suppression of T lymphocyte proliferative response, not merely a reflection of the decrease of helper T cells.

Effects of cimetidine on IL-2 and T suppressor cell function in rats with obstructive jaundice.

Susceptibility to infection in patients with obstructive jaundice is much more higher than non-jaundiced patients. The reasons for this are not completely understood. It is postulated that this may have some relation to changes of patients' immune function. This article reported the changes of splenocyte IL-2 production and T Suppressor cell activity in rats with obstructive jaundice. Meanwhile, we also investigated effects of cimetidine on immune function in rats with bile duct ligation. The results show that IL-2 production in obstructive jaundiced rats significantly decreased and T suppressor cell activity markably increased. Cimetidine could remarkably enhance IL-2 production and suppress T Suppressor cell activity. Abnormality of immune function may be one reason for high susceptibility to infection in patients with obstructive jaundice in perioperative period. Cimetidine, which could clearly improve immune function in rats with obstructive jaundice, might be a valuable agent for strengthening the capacity of fighting infection in patients with obstructive jaundice.

Effect of experimental acute hypertension of the biliary tract on hemodynamics and activity of the major splanchnic nerve in rabbits.

An experimental study of the effect of acute biliary hypertension on hemodynamics and activity of the major splanchnic nerve was conducted in Japanese big ear white rabbits. A catheter with an inflatable rubber bag fixed to its anterior end was inserted into the extrahepatic biliary duct via the duodenum, and a biliary high pressure of 20 kFa (150 mmHg) was created and maintained for 2 h by inflating the bag with water. The right major splanchnic nerve was isolated and the impulse frequencies of the nerve were recorded during the study. Arterial blood pressure was also dynamically monitored. A significant fall of the arterial blood pressure (P less than 0.01) and an increase in impulse frequency of the nerve (P less than 0.01) were found in this "simple type" acute biliary high pressure without infection. Biliary decompression immediately eliminated these abnormalities (P less than 0.01). The drop in blood pressure was much less prominent if the right splanchnic nerve was blocked prior to biliary high pressure.