Immunologische Geschlechtsunterschiede nach abdominalchirurgischem Trauma — Eine Prospektive Untersuchung

Abstract

Introduction: A number of clinical and experimental studies focusing on perioperative immune function indicate significant gender differences. Female mice have been reported to have significantly better specific and unspecific immune functions after hemorrhagic shock and soft tissue trauma. Clinical studies also observed reduced postoperative infection and complication rates in female patients. Moreover, significantly better long-term results after colorectal cancer resections have been reported in females. To address the immunological background of these findings, this prospective study evaluates the perioperative course of B and T lymphocytes following abdominal surgical procedures in male and female patients. Material and Methods: 20 male and 20 female patients with planned abdominal surgical intervention were prospectively enrolled. Absolute cell numbers of B lymphocytes (CD19⁺), T lymphocytes (CD3⁺), T helper (CD3⁺CD4⁺) as well as T suppressor (CD3⁺CD8⁺) lymphocytes were determined by flow cytometry. Blood samples were taken prior to as well as on days one, two and five after surgery. Statistical analysis was done using ANOVA, Dunn’s test and Student-Newman-Keuls test. Results: Following surgical trauma we observed a significant depression of all lymphocyte subpopulations in male patients with minimum values measured on day one after surgery and persistent depression of cell numbers until day five after surgery. In female patients a short-lived (24 h) significant depression of T lymphocyte cell counts was observed while no significant changes of B lymphocyte counts as well as T helper and T suppressor cell counts occurred. Conclusions: Our findings indicate significant gender differences regarding the immune function following elective abdominal surgical trauma with significant advantages for female patients. These observations can help to explain the reported gender differences regarding incidence and mortality of septic complications in surgical patients. Moreover, these immunological gender differences may also contribute to better long-term results after colorectal cancer surgery. Perioperative administration of sex hormone agonists and/or antagonists may, therefore, be a future adjuvant treatment option and requires further clinical experimental evaluation.