Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen S, Denmark.
Int Wound J. 2011 Feb;8(1):33-43. doi: 10.1111/j.1742-481X.2010.00741.x. Epub 2010 Nov 19.
The ability to manage the bioburden in chronic wounds is most likely coupled to the humoral immune response of the patient. We analysed markers of systemic immune response in patients with chronic venous leg ulcers (CVLUs) colonised (no-systemic infection) with the opportunistic pathogen Pseudomonas aeruginosa. Sera from 44 clinically non infected patients with CVLUs were analysed for total IgM and IgG isotype 1-4, complement C3, mannose-binding lectin (MBL), interleukin (IL)-6, C-reactive protein (CRP) and specific anti-P. aeruginosa antibodies against exotoxin A, elastase and alkaline phosphatase. Concentrations of IL-6 versus CRP intercorrelated (β = 2.43 95% CI (1.34-4.34)), but were independent of P. aeruginosa colonisation. MBL deficiency (MBL < 500 ng/ml) correlated to high serum levels of IgG(1) (P = 0.038) consistent with a compensatory mechanism, but not related to presence of P. aeruginosa in the ulcers. Twenty-four patients (54.5%) were culture positive for P. aeruginosa, also conferring significantly high serum levels of complement C3 (P = 0.014), but only two of these had positive titres for antibodies against exotoxin A. All patient sera were negative for antibodies against elastase and alkaline phosphatase. Fluorescent in situ hybridization analysis on randomly selected culture-positive patients could not establish unambiguous presence of P. aeruginosa biofilms in the ulcers. A multiple regression model showed P. aeruginosa and systemic CRP as significant factors in deterioration of ulcer healing rate.
管理慢性伤口生物负荷的能力很可能与患者的体液免疫反应有关。我们分析了患有慢性静脉溃疡（CVLU）且被机会性病原体铜绿假单胞菌定植（无全身感染）的患者的系统免疫反应标志物。分析了 44 例临床无感染的 CVLU 患者的总 IgM 和 IgG 亚型 1-4、补体 C3、甘露糖结合凝集素（MBL）、白细胞介素（IL）-6、C 反应蛋白（CRP）以及针对外毒素 A、弹性蛋白酶和碱性磷酸酶的特异性抗铜绿假单胞菌抗体。IL-6 与 CRP 的浓度呈正相关（β=2.43 95%置信区间（1.34-4.34）），但与铜绿假单胞菌定植无关。MBL 缺乏症（MBL <500ng/ml）与 IgG(1) 血清水平升高相关（P=0.038），这与代偿机制一致，但与溃疡中铜绿假单胞菌的存在无关。24 例（54.5%）患者的培养结果为铜绿假单胞菌阳性，也显著提高了补体 C3 的血清水平（P=0.014），但只有两名患者的外毒素 A 抗体呈阳性。所有患者的血清均对弹性蛋白酶和碱性磷酸酶抗体呈阴性。随机选择培养阳性患者的荧光原位杂交分析不能确定溃疡中是否存在铜绿假单胞菌生物膜的明确存在。多元回归模型显示铜绿假单胞菌和系统 CRP 是溃疡愈合率恶化的显著因素。
