Department of Traumatology, John Hunter Hospital and University of Newcastle, Australia.
Department of Traumatology, John Hunter Hospital and University of Newcastle, Australia.
Med Hypotheses. 2019 Jan;122:141-146. doi: 10.1016/j.mehy.2018.11.016. Epub 2018 Nov 22.
The physiology of tissue healing and aging share common pathways. Both patient age and tissue healing are crucial factors predicting outcomes in trauma patients. The presented hypothesis focuses on the concept that transfused trauma patients have better outcomes when transfused with blood components from young donors. The age of the donor of a blood transfusion could affect recovery following a major traumatic insult and help avoid postinjury immune paralysis and its associated complications. The frequent transfusion of blood components to the severely injured trauma patient provides an opportunity for the recipient to benefit from the potentially favourable effect of blood originating from young donors. Different types of evidence support the presented hypothesis including work on soluble circulating factors, research on animal parabiontic models and epidemiological studies. Theories on the role of transfusion of cells, on bone marrow and on senolytics also represent grounds to elaborate pathways to test this hypothesis. The precise molecular mechanism underlying this hypothesis is uncertain. A beneficial effect on trauma patients following transfusion of blood could be due to a positive effect of blood donated from younger donors or instead to the lack of a negative effect possibly occurring when transfusing blood from older donors. Either way, identifying this mechanism would provide a powerful tool enhance long and short term recovery after trauma.
组织愈合和衰老的生理学有共同的途径。患者年龄和组织愈合都是预测创伤患者结局的关键因素。本研究假设的重点是，输注年轻供体来源的血液成分可改善创伤患者的转归。输血供者的年龄可能影响严重创伤后患者的恢复，并有助于避免损伤后免疫麻痹及其相关并发症。频繁输注血液成分给严重创伤患者为患者从年轻供体来源的血液中获益提供了机会。不同类型的证据支持这一假设，包括可溶性循环因子的研究、动物旁系同生模型的研究和流行病学研究。关于细胞输注、骨髓和衰老细胞清除剂作用的理论也为阐述这一假设提供了依据。这一假设的确切分子机制尚不确定。输血对创伤患者的有益作用可能是由于年轻供体献血的积极作用，也可能是由于输注老年供体血液时可能缺乏负面作用。无论哪种方式，确定这一机制将为增强创伤后长期和短期恢复提供有力工具。
