Blood Systems Research Institute, San Francisco, California 94118, USA.
Transfusion. 2012 Dec;52(12):2533-50. doi: 10.1111/j.1537-2995.2012.03618.x. Epub 2012 Mar 27.
Trauma and transfusion can both alter immunity, and while transfusions are common among traumatically injured patients, few studies have examined their combined effects on immunity.
We tracked the plasma levels of 41 immunomodulatory proteins in 56 trauma patients from time of injury up to 1 year later. In addition, a murine model was developed to distinguish between the effects of transfusion and underlying injury and blood loss.
Thirty-one of the proteins had a significant change over time after traumatic injury, with a mixed early response that was predominantly anti-inflammatory followed by a later increase in proteins involved in wound healing and homeostasis. Results from the murine model revealed similar cytokine responses to humans. In mice, trauma and hemorrhage caused early perturbations in a number of the pro- and anti-inflammatory mediators measured, and transfusion blunted early elevations in interleukin (IL)-6, IL-10, matrix metalloproteinase-9, and interferon-γ. Transfusion caused or exacerbated changes in monocyte chemotactic protein-1, IL-1α, IL-5, IL-15, and soluble E-selectin. Finally, trauma and hemorrhage alone increased CXCL1 and IL-13.
This work provides a detailed characterization of the major shift in the immunologic environment in response to trauma and transfusion and clarifies which immune mediators are affected by trauma and hemorrhage and which by transfusion.
创伤和输血都会改变免疫功能，而创伤患者中输血较为常见，但很少有研究探讨它们对免疫功能的综合影响。
我们对 56 名创伤患者从受伤时到 1 年后的血浆中 41 种免疫调节蛋白的水平进行了追踪。此外，还建立了一种小鼠模型，以区分输血和潜在损伤及失血的影响。
31 种蛋白在创伤后随时间发生显著变化，早期反应呈混合性，主要为抗炎反应，随后参与伤口愈合和内稳态的蛋白增加。来自小鼠模型的结果显示出与人类相似的细胞因子反应。在小鼠中，创伤和出血导致了所测量的许多促炎和抗炎介质的早期波动，而输血则使 IL-6、IL-10、基质金属蛋白酶-9 和干扰素-γ的早期升高受到抑制。输血导致或加剧了单核细胞趋化蛋白-1、IL-1α、IL-5、IL-15 和可溶性 E-选择素的变化。最后，单独的创伤和出血增加了 CXCL1 和 IL-13。
这项工作详细描述了创伤和输血引起的免疫环境的主要变化，并阐明了哪些免疫介质受创伤和出血影响，哪些受输血影响。
