Malhotra Ajai K, Carter Richard F, Lebman Deborah A, Carter Dawn S, Riaz Omer J, Aboutanos Michel B, Duane Therese M, Ivatury Rao R
Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA.
J Trauma. 2010 Nov;69(5):1126-30; discussion 1130-1. doi: 10.1097/TA.0b013e3181f9fa1e.
Splenic artery angioembolization (SAE) is increasingly being used as an adjunct to nonoperative management for stable patients with blunt splenic injury (BSI). However, little is known about splenic immunocompetence after SAE. This study aims at assessing splenic immunocompetence after SAE for BSI.
Peripheral blood was obtained from BSI patients (n = 8) who had SAE >6 months prior. Splenic immunocompetence was assessed by isolating mononuclear cells and incubating with CD4 and CD45RA and CD45RO antibody to analyze the proportion of T-cells expressing CD4 receptor, or coexpressing CD4 and either CD45RA or CD45RO receptors. Cells were counted by fluorescence-activated cell sorting and compared with trauma patients that had splenectomy for BSI also >6 months prior (n = 4, negative controls) and normal healthy volunteers with intact spleens (n = 4, positive controls).
The test was discriminatory for the asplenic state. %CD4 cells were significantly lower in splenectomized patients (16 ± 1) versus normal (40 ± 2), p < 0.05. This was due to significant decrease (8 ± 2 vs. 26 ± 4, p < 0.05) in %CD4CD45RA cells whereas the proportion of CD4CD45RO cells were maintained similar to normal. SAE patients had values (CD4, 36 ± 2, and CD4CD45RA, 24 ± 2) comparable to normal (p > 0.05) and significantly higher than splenectomized patients (p < 0.05). When the SAE group was subdivided into main (total, n = 4) and branch vessel (partial, n = 4) SAE, results were the same for both types of SAE.
Splenic immune function, measured by T-cell subset, generated only in the presence of an immunocompetent spleen, is preserved after SAE for BSI, main or partial.
脾动脉血管栓塞术（SAE）越来越多地被用作钝性脾损伤（BSI）稳定患者非手术治疗的辅助手段。然而，关于SAE术后脾免疫功能的了解甚少。本研究旨在评估BSI患者SAE术后的脾免疫功能。
从SAE超过6个月的BSI患者（n = 8）中获取外周血。通过分离单核细胞并与CD4、CD45RA和CD45RO抗体孵育来评估脾免疫功能，以分析表达CD4受体的T细胞比例，或共表达CD4以及CD45RA或CD45RO受体的T细胞比例。通过荧光激活细胞分选对细胞进行计数，并与同样在6个月前因BSI行脾切除术的创伤患者（n = 4，阴性对照）以及脾脏完整的正常健康志愿者（n = 4，阳性对照）进行比较。
该检测对无脾状态具有鉴别性。脾切除患者的%CD4细胞（16 ± 1）显著低于正常组（40 ± 2），p < 0.05。这是由于%CD4CD45RA细胞显著减少（8 ± 2对26 ± 4，p < 0.05），而CD4CD45RO细胞的比例与正常组相似。SAE患者的值（CD4，36 ± 2，CD4CD45RA，24 ± 2）与正常组相当（p > 0.05），且显著高于脾切除患者（p < 0.05）。当将SAE组细分为主干（全部，n = 4）和分支血管（部分，n = 4）SAE时，两种类型的SAE结果相同。
通过T细胞亚群测量的脾免疫功能仅在具有免疫活性的脾脏存在时产生，在BSI患者进行主干或部分SAE术后得以保留。
