Valente Stephanie A, Fallon William F, Alexander Thomas S, Tomas Ervin R, Evancho-Chapman M Michelle, Schmidt Steven P, Gorski Rachelle, Pizov Olga, DeFine Linda, Clark Aaron J
Department of Surgery, Summa Health System, Akron City Hospital, Akron, Ohio 44304, USA.
J Trauma. 2009 Nov;67(5):968-74. doi: 10.1097/TA.0b013e3181b84279.
Aging is associated with a decline in immune function. This may contribute to decreased ability of an elderly patient to mount an appropriate innate inflammatory response when injured. This study examined elderly trauma patients to determine whether there was a difference in neutrophil response to injury when compared with controls.
This prospective, observational, cohort study compared neutrophil function in 24 injured elderly (older than 65 years) patients admitted to our trauma center to control groups of noninjured individuals (11 elderly and 17 young). Blood samples were also taken from the injured elderly group within 48 hours of trauma and subsequently at two periods during their hospital stay. A single blood sample was obtained from the noninjured control groups. Neutrophils were analyzed for CD18 expression, stimulated oxidative burst, apoptosis, and IL-10. Results were compared using one-way analysis of variance (alpha 0.05). This study was approved by the Institutional Review Board.
Twenty-four injured elderly subjects were enrolled: mean injury severity score 15.3, average age 74.6 years, 92% survival, 100% blunt trauma. CD18 levels in the elderly injured subjects for all three time periods were significantly higher than both control groups. When evaluated between controls, CD18 for the noninjured elderly (NIE) was also significantly higher than the noninjured young (NIY). The neutrophil stimulated oxidative burst in the injured elderly subjects at time periods 1, 2, and 3 was not significantly different from the NIY controls. However, the injured elderly had a significantly higher oxidative burst at time period 3 than the NIE controls. Apoptosis in the injured elderly subjects was significantly lower in all three time periods than the NIY. There was no difference in apoptosis between the injured elderly subjects when compared with the NIE controls. There was no significant difference in IL-10 expression among groups.
Injury results in differences in innate immune function in the elderly when compared with controls. The clinical significance of this is uncertain and warrants further investigation.
衰老与免疫功能下降有关。这可能导致老年患者受伤时产生适当先天性炎症反应的能力下降。本研究对老年创伤患者进行检查，以确定与对照组相比，其对损伤的中性粒细胞反应是否存在差异。
这项前瞻性观察性队列研究将24名入住我们创伤中心的受伤老年（65岁以上）患者的中性粒细胞功能与未受伤个体的对照组（11名老年人和17名年轻人）进行比较。在创伤后48小时内以及随后住院期间的两个时间段，也从受伤老年组采集血样。从未受伤对照组采集单一血样。分析中性粒细胞的CD18表达、刺激后的氧化爆发、凋亡和白细胞介素-10。使用单因素方差分析比较结果（α=0.05）。本研究获得机构审查委员会批准。
纳入24名受伤老年受试者：平均损伤严重程度评分为15.3，平均年龄74.6岁，生存率92%，钝性创伤100%。在所有三个时间段，受伤老年受试者的CD18水平均显著高于两个对照组。在对照组之间进行评估时，未受伤老年人（NIE）的CD18也显著高于未受伤年轻人（NIY）。在第1、2和3时间段，受伤老年受试者的中性粒细胞刺激后的氧化爆发与NIY对照组无显著差异。然而，受伤老年人在第3时间段的氧化爆发显著高于NIE对照组。在所有三个时间段，受伤老年受试者的凋亡均显著低于NIY。与NIE对照组相比，受伤老年受试者之间的凋亡无差异。各组间白细胞介素-10表达无显著差异。
与对照组相比，损伤导致老年人先天性免疫功能存在差异。其临床意义尚不确定，值得进一步研究。
