Ford E G, Hennessey P J, Jennings L M, Black T, Andrassy R J
Department of Surgery, University of Texas Health Science Center, Houston.
J Pediatr Surg. 1989 Aug;24(8):815-7. doi: 10.1016/s0022-3468(89)80543-3.
Early augmentation of a patient's immune system can be a valuable adjunct to standard supportive and antibiotic treatment of overwhelming postsplenectomy sepsis (OPSS). Normal humoral immune factors against pneumococcal sepsis are replenished by the parenteral administration of human gamma-globulin (HGG). Monthly prophylactic administration of HGG to asplenic individuals to prevent OPSS has been suggested. The cost of such measures is prohibitive, and the risk of serum-transmitted disease is significant. We administered HGG to splenectomized infant rats with pneumococcal sepsis to determine if mortality rates could be reduced and survival time prolonged. Fifty-six three-day-old rats underwent splenectomy and another 56, laparotomy without splenectomy. Twenty-eight animals from each operative group were administered HGG and the other 28, human serum albumin (HSA), 12 and 24 hours after inoculation with varying dosages of log-phase Streptococcus pneumoniae. The LD50 for asplenic animals was less than 50 colony forming units (cfu) per animal, while for the group with spleens, the LD50 was 250 to 500 cfu. There were no significant intragroup variations in LD50 between HGG and HSA subgroups. Survival times were compared using the BMDP1L-Life Tables and Survival Functions, and the generalized Wilcoxon t-test. These data show that host immunity to pneumococcal challenge in asplenic infant animals might be fully restored by the administration of HGG, even after the onset of symptoms. Survival of an asplenic child with evidence of OPSS might be enhanced by immediate administration of HGG.
早期增强患者的免疫系统对于暴发性脾切除术后败血症（OPSS）的标准支持治疗和抗生素治疗而言可能是一种有价值的辅助手段。通过肠胃外注射人γ-球蛋白（HGG）可补充针对肺炎球菌败血症的正常体液免疫因子。有人建议对无脾个体每月预防性注射HGG以预防OPSS。但这些措施的成本过高，且血清传播疾病的风险很大。我们对患有肺炎球菌败血症的脾切除幼鼠注射HGG，以确定是否可以降低死亡率并延长存活时间。56只3日龄大鼠接受了脾切除术，另外56只接受了未切除脾脏的剖腹术。每个手术组的28只动物在接种不同剂量的对数期肺炎链球菌12和24小时后注射HGG，另外28只注射人血清白蛋白（HSA）。无脾动物的半数致死量（LD50）小于每只动物50个菌落形成单位（cfu），而有脾脏的组LD50为250至500 cfu。HGG和HSA亚组之间的LD50在组内无显著差异。使用BMDP1L生命表和生存函数以及广义威尔科克森t检验比较存活时间。这些数据表明，即使在症状出现后，对无脾幼龄动物注射HGG也可能完全恢复其对肺炎球菌攻击的宿主免疫力。立即注射HGG可能会提高患有OPSS证据的无脾儿童的存活率。
