Vykhtyuk T. I., Lapovets L. E.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The need to improve the efficiency of treatment and rehabilitation of patients, who have developed infectious complications of postoperative wounds after the reconstruction for critical limb ischemia (CLI), necessitates a deeper study and understanding of the pathogenetic mechanisms of the development of surgical site infection (SSI). The immunopathogenesis of infectious complications of postoperative wounds, namely the importance of the system of cytokine regulation in their development, is of particular interest. The cytokine network includes a large group of low molecular weight compounds that participate in complex mechanisms of development of inflammatory reactions, determine the type and duration of immune response, and provide regulation of vascular tone, processes of hemostasis and blood cell proliferation. Due to high prevalence of SSI in clinical practice, the role of pro- and anti-inflammatory cytokines as markers of local postoperative inflammation of soft tissues of the lower extremities is relevant. Therefore, the objective of our study was to investigate the content of proinflammatory TNF-αand IL-6 and anti-inflammatory IL-2 and IL-10 cytokines in patients with postoperative wound complications after reconstructive interventions for CLI, but also to evaluate the studied parameters depending on SSI stages. The object and methods of the study.The study of individual pro-and anti-inflammatory immune parameters was conducted in 135 people with complicated postoperative infectious wounds after reconstructive surgery on great vessels of the lower limbs, who constituted the study group. The control group included 41 persons, who developed complicated post-operative wounds of non-infectious origin after surgery for CLI. Stages of infectious lesion of soft tissues after the reconstruction were determined by Szilagyi classification (1972). The content of proinflammatory TNF-αand IL-6 cytokines and anti-inflammatory IL-2 and IL-10 cytokines in blood serum was investigated to assess the immune status of patients with SSI. Blood sample collection was carried out on the first day after detecting complications of postoperative wounds in the morning on an empty stomach. The study of immunological parameters was performed by the immunoassay method (ELISA) using the sets of CJSC Vector-Best (Russia) in accordance with the manufacturer recommendations and instructions. Statistical data was computed using Statistica 8.0 software. Study results and their discussion. The results of the study with the determination of the quantitative content of proinflammatory TNF-α, IL-6 cytokines and anti-inflammatory IL-2 and IL-10 cytokines in blood serum of patients of the studied groups are presented in Table 1. There was a significant (p<0.001) increase in the levels of proinflammatory IL-6 and TNF-αcytokines in patients of the study group in comparison with patients in the control group. At the same time, the content of antiinflammatory IL-2 and IL-10 cytokines in serum of patients in the study group was significantly lower (p<0.001) than in the controls. Table 2 shows the results of determining the concentrations of immunological parameters studied in the study group patients at different stages of SSI course. The obtained data revealed a significantly (p<0.001) higher level of proinflammatory IL-6 (142.03±1.51 pg/ml) and TNF-α(30.17±0.17 pg/ml) cytokines in patients with stage III of the postoperative wound lesions by Szilagyi classification than in patients with II and I stages of postoperative wound lesions. The levels of anti-inflammatory IL-2 and IL-10 cytokines in serum were significantly lower in individuals with stage III SSI by Szilagyi than in patients at stages II and I. Infectious postoperative wound lesions were characterized by different depth (Table 3). The depth of postoperative wound was superficial in 51 patients with stage I of the postoperative wound infections, classified by Szilagyi, which accounted for 37.78±4.17% of all patients in the study group, and 84 patients with stage II and III SSI (62.22±4.17%) had deep infectious lesion of the postoperative wound. Levels of proinflammatory IL-6 and TNF-αcytokines were higher in the study group patients with deep postoperative wound lesions, compared with the corresponding indices of patients in the study group with superficial lesions of the postoperative wound (p<0.001). Conversely, the concentrations of anti-inflammatory IL-2 and IL-10 cytokines were lower among patients in the study group with deep postoperative wound lesions. Simultaneous comparison of the levels of the studied blood serum parameters of patients in four different types of postoperative wound complications depending on the depth of infectious lesions and the type of noninfectious complications were significant (p<0.001). The levels of proinflammatory cytokines were lower, and the concentrations of anti-inflammatory cytokines were higher in patients with both lymphocele and marginal necrosis than in patients of the study group (p<0.001), both in the presence of superficial and deep postoperative wound lesions. Conclusion.The obtained data indicate that the development of infectious complications of postoperative wounds after the postoperative reconstruction for CLI operative surgery occurs in the settings of marked impairment of cytokine regulation. The latter was manifested by an increase in the concentration of proinflammatory TNF-αand IL-6 cytokines and a decrease in the concentration of anti-inflammatory IL-2 and IL-10 cytokines in blood serum of patients with developed SSI, which significantly differed from those of the control group. The study of the content of individual immunological parameters indicates the activation of proinflammatory mechanisms of the cytokine balance system in the settings of infected postoperative wounds in relation to lymphatic and ischemic complications. The severity of changes in the studied parameters increased with an increase in the depth of the infectious postoperative wound lesions.

critical limb ischemia, surgical site infection, proinflammatory and anti-inflammatory cytokines

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«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 113-117 pages, index UDK 617.58:616.13/.16]-005.4-089.844-022.1-07:616.155.3-097.37-07

10.29254/2077-4214-2018-1-1-142-113-117