Yadav Kabir, Zehtabchi Shahriar, Nemes Petru C, Miller Andrew C, Azher Mohammed, Durkin Helen, Sinert Richard
Department of Emergency Medicine, State University of New York, Downstate Medical Center/Kings County Hospital, Brooklyn, New York 11203, USA.
Resuscitation. 2009 Jan;80(1):83-8. doi: 10.1016/j.resuscitation.2008.09.012. Epub 2008 Nov 7.
A traumatic insult initiates an inflammatory cascade, which is a contributor to cell damage and could be a marker of injury severity.
To compare the initial and 4-h post-injury lymphocyte subsets and cytokine levels between patients with minor and major injury.
Prospective, cross-sectional study of trauma patients in an urban level I trauma center.
Adult patients with significant mechanism of injury requiring admission.
cell counts (B-cells, Natural Killer cells, monocytes; and CD4 and CD8 T lymphocytes) and cytokines (IL-1, IL-5, IL-6, IL-10, and TNFalpha). We divided subjects into two groups (major and minor injury). We defined major injury as an injury severity score > or =15, or drop in hematocrit > or =10 points or blood transfusion requirement.
Univariate analysis was performed using each inflammatory marker, and multivariate logistic regression analysis was performed to identify the inflammatory markers associated with major injury.
79 patients were studied (mean age: 35+/-17, age range: 13-88, 84% male, 38% penetrating trauma, 96% African-American). 25% of patients (n=20) experienced major injury. Larger base deficit (-3.6+/-6.2 vs. -0.9+/-4.2) levels were observed in major trauma patients. We found that major injury is associated with a drop in absolute CD4 cell count (but not in the CD8 cells), a rise in absolute B-cell count (but not in the NK-cells or monocytes), and a rise in IL-6 (but not in the IL-1, IL-5, IL-10, TNF-a).
We found evidence of a measurable early inflammatory response to trauma, using cytokine levels and lymphocyte subset counts.
创伤性损伤引发炎症级联反应，这是导致细胞损伤的一个因素，且可能是损伤严重程度的一个指标。
比较轻伤和重伤患者伤后即刻及伤后4小时的淋巴细胞亚群和细胞因子水平。
对一家城市一级创伤中心的创伤患者进行前瞻性横断面研究。
因严重损伤机制而需要住院的成年患者。
细胞计数（B细胞、自然杀伤细胞、单核细胞；以及CD4和CD8 T淋巴细胞）和细胞因子（IL-1、IL-5、IL-6、IL-10和TNFα）。我们将受试者分为两组（重伤和轻伤）。我们将重伤定义为损伤严重程度评分≥15，或血细胞比容下降≥10个百分点或需要输血。
使用每种炎症标志物进行单变量分析，并进行多变量逻辑回归分析以确定与重伤相关的炎症标志物。
研究了79例患者（平均年龄：35±17岁，年龄范围：13 - 88岁，84%为男性，38%为穿透性创伤，96%为非裔美国人）。25%的患者（n = 20）经历了重伤。重伤患者的碱剩余水平更高（-3.6±6.2 vs. -0.9±4.2）。我们发现重伤与绝对CD4细胞计数下降（但CD8细胞无下降）、绝对B细胞计数升高（但自然杀伤细胞或单核细胞无升高）以及IL-6升高（但IL-1、IL-5、IL-10、TNF-α无升高）有关。
我们发现利用细胞因子水平和淋巴细胞亚群计数可检测到创伤后早期可测量的炎症反应。
