Tıkanma sarılığında hiperterminin bakteriyel translokasyon üzerine etkisi

Abstract

BULGULARIN OZETI Kolestaz ortaya çıkmadan önce uygulanan hiperterminin, sitotoksik T hücrelerini ( CD8 ) normotermi grubuna göre anlamlı bir şekilde azalttığı gözlenmiştir. Aynı zamanda,kolestaz ortaya çıkmadan önce uygulanan hiperterminin yardımcı T hücre / sitotoksik T hücre oranım ( CD4/CD8 ) anlamlı bir şekilde arttırdığı gösterilmiştir. Sanlık öncesinde uygulanan hipertermi, NK hücrelerini normotermi grubuna göre anlamlı bir şekilde arttırmıştır. Tıkanma sanlığı oluşturulduktan sonra uygulanan hiperterminin immun sistem üzerinde herhangi bir olumlu etkisi gösterilememiştir. Bu grupta bakılan immünolojik parametrelerin hiçbiri istatistiksel olarak anlamlı değildir. Kolestazdan sonra uygulanan hiperterminin, önkoşullandırma görevini yapamayıp, sanlığın indükte ettiği ve birçok organ ve sistem üzerindeki travmatik etkisini daha belirgin hale getirerek bakteriyel translokasyonu arttırdığı gösterilmiştir. Hipertermi kolestaz öncesinde uygulandığında, önkoşullandırma görevini yaparak immun sistemi daha güçlü hale getirebilmiştir. Ancak, bakteriyel translokasyon üzerinde herhangi bir olumlu etki oluşturamamıştır. 35

SUMMARY Obstructive jaundice is a difficult clinical entity that is often complicated with impairement of multiple organ and system functions. Hepatic, renal, gastrointestinal as well as immune system insufficiencies increase the complications accompanying surgery in this group leading to more encountered morbidity and mortality. Many methods have been tried to palliate jaundice in an attempt to decrease complication rates in these patients. Most of them were unpromising. In this study, the role of hyperthermic preconditioning ( 42 °C for 15 minutes ) was investigated in mechanically jaundiced rat model. Its role on both immune system and bacterial translocation has been studied. Common bile duct was ligated proximally near the hepatic hilus in four groups for seven days. Each group being composed of 8 rats. Hyperthermia was done both before and after obstructive jaundice in two different groups. Results indicated that hyperthermia could not play a preconditioning role on the immune system of jaundiced rats, however it could increase both the ratio of Helper/Supressor T lymphocytes and the percentage of natural killer cells, hence reinforcing the cellular immunity in rats undergoing hyperthermia before the appearance of jaundice. Concerning bacterial translocation, hyperthermia played a traumatic role when done after common bile duct ligation. Bacterial translocation was detected in the liver, spleen and mesenteric lymph nodes in half of the rats in this group, and the microbial population of the ceacum increased as well. When done before 36jaundice, although it strengthened the immune system, it could not play any protective role against the occurence of bacterial translocation. We concluded that hvperthermia as a preconditioning method, does not have any beneficial effect on the occurence of bacterial translocation in jaundiced rats, and was considered traumatic more than a preconditioning method in this concern. On the contrary, hvperthermia was helpful in strengthening the immune system when done before the occurence of obstructive jaundice but still could not plav any protective role against bacterial translocation when compared to the sham group. 37