Smith R M
Orthopaedic Trauma Service, Harvard Medical School, Massachusetts General Hospital, YAW 3600-3C, 55 Fruit Street, Boston, MA 02114, United States.
Injury. 2007 Dec;38(12):1401-4. doi: 10.1016/j.injury.2007.09.013. Epub 2007 Nov 28.
It is believed that an uncontrolled or poorly coordinated immune reaction can be stimulated by major trauma and be responsible for the development of the multiple organ dysfunction syndrome (MODS). The elderly have a reduced ability to mount an effective immune reaction with deficiencies involving both humoral and cellular aspects of immunity that involve poor function of both the stimulatory and immuno-suppressive sides of the immune process. However, there is currently no hard evidence that the excess mortality after major trauma in the elderly is associated with an impaired or excessive immune response. It is possible that their poor resistance to infection is important and immune modulated but the dominant factor in the excess mortality in the elderly population is probably associated with their lack of physiological reserve to respond to a major physiological challenge.
人们认为，严重创伤可引发不受控制或协调不良的免疫反应，并导致多器官功能障碍综合征（MODS）的发生。老年人产生有效免疫反应的能力下降，体液免疫和细胞免疫方面均存在缺陷，免疫过程的刺激和免疫抑制功能均较差。然而，目前尚无确凿证据表明老年人严重创伤后的高死亡率与免疫反应受损或过度有关。他们对感染的抵抗力差可能很重要且受到免疫调节，但老年人群高死亡率的主要因素可能与其缺乏应对重大生理挑战的生理储备有关。
