Reikerås Olav, Sun Jingbo, Wang Jacob E, Foster Simon J, Aasen Ansgar O
Department of Orthopaedics, Rikshospitalet University Clinic, University of Oslo, Norway.
J Invest Surg. 2008 Sep-Oct;21(5):255-60. doi: 10.1080/08941930802180128.
Trauma is associated with immune paresis which may predispose to postoperative sepsis. We characterized the ex vivo cytokine responses to bacterial cell wall components in whole blood from 8 patients undergoing a major musculoskeletal trauma in the form of total hip replacement. Preoperatively, at the end of operation, and at days 1 and 6 postoperatively, patient blood was obtained, anticoagulated, and incubated at 37 degrees C in the presence of peptidoglycan (PepG) or lipopolysaccharide (LPS). Plasma cytokines were measured by enzyme immunoassay. The numbers of leucocytes, monocytes, and neutrophils were unchanged at the end of surgery, while there were significant increases at postoperative days 1 and 6. We observed significant reductions in tumor necrosis factor-alpha (TNF-alpha) and interleukin 10 (IL-10) responses to PepG at the end of surgery, which was disproportional to the nonsignificant reductions in circulating monocytes, suggesting a functional suppression. However, at postoperative day 1 the responses were recovered. There were no significant changes in responses of TNF-alpha to LPS stimulation at the end of surgery, while there were significant depressions at postoperative days 1 and 6. The expression of IL-10 was significantly depressed at the end of surgery and at day 6. There were modest changes in PepG- and LPS-induced expression of interleukin 8 (IL-8) during the experiments. On the basis of these observations, we conclude that a musculoskeletal trauma is associated with reduced expression of TNF-alpha and IL-10 by whole blood leucocytes when exposed to endotoxin, but there is a difference between gram-positive endotoxin (PepG) and gram-negative endotoxin (LPS).
创伤与免疫麻痹相关，这可能会增加术后发生败血症的风险。我们对8例接受全髋关节置换这种严重肌肉骨骼创伤手术的患者全血中细菌细胞壁成分的体外细胞因子反应进行了表征。术前、手术结束时以及术后第1天和第6天采集患者血液，进行抗凝处理，并在肽聚糖（PepG）或脂多糖（LPS）存在的情况下于37℃孵育。通过酶免疫测定法检测血浆细胞因子。手术结束时白细胞、单核细胞和中性粒细胞数量未发生变化，而在术后第1天和第6天显著增加。我们观察到手术结束时对PepG的肿瘤坏死因子-α（TNF-α）和白细胞介素10（IL-10）反应显著降低，这与循环单核细胞数量的非显著减少不成比例，提示存在功能抑制。然而，在术后第1天反应恢复。手术结束时TNF-α对LPS刺激的反应无显著变化，而在术后第1天和第6天显著降低。手术结束时和第6天IL-10的表达显著降低。实验期间PepG和LPS诱导的白细胞介素8（IL-8）表达有适度变化。基于这些观察结果，我们得出结论，肌肉骨骼创伤与全血白细胞在暴露于内毒素时TNF-α和IL-10表达降低有关，但革兰氏阳性内毒素（PepG）和革兰氏阴性内毒素（LPS）之间存在差异。
