Livingston D H, Appel S H, Wellhausen S R, Sonnenfeld G, Polk H C
Department of Surgery, Price Institute of Surgical Research, School of Medicine, University of Louisville, KY 40292.
Arch Surg. 1988 Nov;123(11):1309-12. doi: 10.1001/archsurg.1988.01400350023002.
Monocyte HLA-DR antigen expression and mitogen-stimulated interferon gamma production were measured sequentially on days 1, 3, 7, 14, and 21 after admission in 20 multiply injured patients (mean Injury Severity Score, 33). Ten patients recovered uneventfully and ten developed a major infection, three of whom died. Trauma resulted in immediate and profound depression of both interferon gamma production and monocyte HLA-DR antigen expression compared with controls. Interferon gamma remained below control levels for all days on which it was measured in all patients. In uninfected patients, interferon gamma production began to recover after day 7 and interferon gamma levels on day 21 were greater than on all other days. Monocyte HLA-DR antigen expression returned to normal between days 7 and 14 in uninfected patients, despite subnormal production of interferon gamma. Failure to increase interferon gamma production and monocyte HLA-DR antigen expression was associated with an episode of major infection. We postulate that stimulation of the immune system early after injury may reverse the defects reported and decrease the incidence of infection after severe trauma.
在20例多发伤患者（平均损伤严重度评分33分）入院后的第1、3、7、14和21天，依次检测单核细胞人类白细胞抗原-DR（HLA-DR）抗原表达及丝裂原刺激的γ干扰素产生情况。10例患者顺利康复，10例发生严重感染，其中3例死亡。与对照组相比，创伤导致γ干扰素产生及单核细胞HLA-DR抗原表达立即且显著降低。在所有患者检测γ干扰素的日子里，其水平均低于对照组。在未感染患者中，γ干扰素产生在第7天后开始恢复，第21天的γ干扰素水平高于其他所有日子。尽管γ干扰素产生低于正常水平，但未感染患者的单核细胞HLA-DR抗原表达在第7至14天恢复正常。未能增加γ干扰素产生及单核细胞HLA-DR抗原表达与严重感染发作相关。我们推测，在损伤后早期刺激免疫系统可能逆转所报道的缺陷并降低严重创伤后感染的发生率。
