Regel G, Dwenger A, Gratz K F, Nerlich M L, Sturm J A, Tscherne H
Unfallchirurg. 1989 Jul;92(7):314-20.
The influence of trauma and hemorrhagic shock on the non-specific immune system has been pointed out in various experimental studies. Other investigations have also been able to find a relationship between these changes and a higher incidence of post-traumatic complications in the form of organ failure. Our aim was to demonstrate the potential changes in the cellular defense system in a clinical study on multiple trauma patients. The polymorphonuclear leukocytes (PMNL) are the main representative of the mobile, non-specific immune system. Our study revealed a significant deterioration of PMNL function after trauma. The metabolic activity and phagocytic function were mainly affected by a decrease in the concentration of so-called "opsonins." The opsonins are important for the identification and engulfment of debris (necrosis, fat emboli and thrombi) and bacterial substances (endotoxin). Next to the opsonin level, a change in the receptor configuration is important for phagocytosis. However, we could not find any substantial evidence of surface receptor alteration. The reticuloendothelial cells (RES), a stationary phagocytic system, also showed a significant reduction in clearance function in these polytraumatized patients. Similar to PMNL, these disturbances were based on the reduction of the opsonine concentration. We were able to demonstrate a significant disturbance in immune function in multiple trauma patients with post-traumatic complications compared to patients with a normal clinical course after injury. Disturbances in the PMNL function (seen after 4 days) were found to appear after the RES disturbances. Systemic interaction between these two phagocytic systems cannot be excluded and further investigation is therefore required.
各种实验研究均指出了创伤和失血性休克对非特异性免疫系统的影响。其他调查也发现这些变化与创伤后器官功能衰竭形式的并发症发生率较高之间存在关联。我们的目的是在一项针对多发伤患者的临床研究中证明细胞防御系统的潜在变化。多形核白细胞（PMNL）是移动性非特异性免疫系统的主要代表。我们的研究显示创伤后PMNL功能显著恶化。代谢活性和吞噬功能主要受所谓“调理素”浓度降低的影响。调理素对于识别和吞噬碎片（坏死组织、脂肪栓子和血栓）以及细菌物质（内毒素）很重要。除了调理素水平外，受体构型的变化对吞噬作用也很重要。然而，我们没有发现任何表面受体改变的实质性证据。网状内皮细胞（RES），一种固定的吞噬系统，在这些多发伤患者中也显示出清除功能显著降低。与PMNL类似，这些紊乱是基于调理素浓度的降低。与伤后临床过程正常的患者相比，我们能够证明创伤后有并发症的多发伤患者免疫功能存在显著紊乱。发现PMNL功能紊乱（在4天后出现）出现在RES紊乱之后。不能排除这两个吞噬系统之间的全身相互作用，因此需要进一步研究。
