engleski

THE EFFECT OF EPIDURAL ANESTHESIA ON PERFORIN EXPRESSION IN PATIENTS WITH COLORECTAL CARCINOMA

The postoperative period is accompaned with neuroendocrine, metabolic and immune alteration which are caused by tissue damage, anesthesia, postoperative pain and psychological stress. It is well known that suppression of immune response was marked in postoperative period. Postoperative pain contributs to dysfunction of immune response as a result of interaction between central nervous and immune systems. The postoperatively activated hypotalamo-pituitary-adrenocortical and sympatoadrenal axis are important modulators of immune response. Afferent neural blockade by epidural analgesia can decrease neuroendocrine stress response. According to bidirectional communication of immune and nervous system, appropriate postoperative pain management could affect immune response in postoperative period. The aim of this study was to examine alteration of cell mediated immunity and cytolytic molecule perforin in different lymphocyte subpopulation in peripheral blood of patient after resection of colorectal carcinoma when postoperative pain is reduced by epidural analgesia. Venous blood samples were taken and peripheral blood leukocytes (PBL) were isolated. Phenotype of lymphocytes and perforin expression were analyzed using intracellular and surface immunofluoresecncy and flow cytometric analysis (FACSCalibur). The results demonstrated that 20-30% of PBL in all examine group are perforin positive (total perforin is significantly higher than in control group). These results suggest that human perforin is differentially expressed in distinct sub-populations of peripheral blood lymphocytes of patients with colorectal carcinoma, implicating the important role of perforin positive cells in na&iuml ; ; ve immune response and cytotoxic activity of peripheral blood lymphocytes.

colorectal carcinoma; epidural analgesia; perforin; postoperative stress

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