Pallister Ian, Bhatia Raj, Katpalli Gopi, Allison Dawn, Parker Clare, Topley Nicholas
Department of Trauma & Orthopaedics, Morriston Hospital, Swansea NHS Trust, UK.
J Trauma. 2006 Apr;60(4):844-50. doi: 10.1097/01.ta.0000215583.08765.ce.
Post-traumatic MOF results from local tissue injury because of migration and activation of dysfunctional polymorphonuclear leukocytes (PMN). Although fracture surgery exacerbates the postinjury inflammatory response, it is usually beneficial. This study compared changes in PMN receptor expression and migratory activity, in whole blood and following PMN isolation.
IL-8 mediated PMN migration and expression of CXCR-1, CD11b, and CD18 was studied in isolated and whole blood PMN in normal controls. Migration was studied at admission and day 5 after surgery in trauma patients undergoing fracture surgery.
PMN isolation results in increased expression of surface receptors and enhanced migration in normal controls. In trauma patient samples, isolated PMN migration is enhanced after injury, but suppressed when migration from whole blood is studied, both after injury and fracture surgery.
PMN isolation results in priming for migration, which has a relatively greater impact upon PMN in trauma patients. The observation that PMN activity may decline but priming potential remains enhanced is novel. Further refinements of whole blood and isolated PMN techniques are clearly warranted. This may help to resolve the mismatch in clinical and scientific experience in those patients with major fractures requiring surgical stabilization.
创伤后多器官功能衰竭是由于功能失调的多形核白细胞（PMN）迁移和激活导致局部组织损伤所致。尽管骨折手术会加剧损伤后的炎症反应，但通常是有益的。本研究比较了全血及PMN分离后PMN受体表达和迁移活性的变化。
在正常对照的分离的和全血PMN中研究白细胞介素-8介导的PMN迁移以及CXCR-1、CD11b和CD18的表达。对接受骨折手术的创伤患者在入院时及术后第5天研究迁移情况。
在正常对照中，PMN分离导致表面受体表达增加和迁移增强。在创伤患者样本中，分离的PMN迁移在损伤后增强，但在研究损伤后及骨折手术后全血中的迁移时受到抑制。
PMN分离导致迁移的启动，这对创伤患者的PMN影响相对更大。PMN活性可能下降但启动潜能仍增强这一观察结果是新颖的。显然有必要进一步改进全血和分离PMN的技术。这可能有助于解决那些需要手术稳定的严重骨折患者临床和科学经验不匹配的问题。
