Department of Trauma Surgery, University Hospital Munich, Ludwig-Maximilians University, Nussbaumstr. 20, 80336 Munich, Germany.
Department of Trauma Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
J Immunol Res. 2020 Mar 9;2020:4936374. doi: 10.1155/2020/4936374. eCollection 2020.
Patients after polytrauma regularly suffer from posttraumatic immune system destabilization, which closely influences the further clinical development. Increasing age has recently been identified as an isolated risk factor for an adverse outcome after major trauma. Higher rates and intensity of acute inflammation following severe injury suggest that deregulated inflammation may contribute to these higher rates of posttraumatic morbidity and mortality in older adults. MMP-9 and TIMP-1 have been found to play a major role in posttraumatic immune disorder in a previous genome-wide mRNA analysis.
The aim of this study was to evaluate the differences in serum protein dynamics in older and younger polytraumatized adults.
Blood samples were drawn immediately within 90 minutes after trauma and subsequently after 6, 12, 24, 48, and 72 h. Serum levels of TIMP-1 and MMP-9 were quantified using ELISA. Age groups were divided according to a cutoff of 60 years.
60 polytrauma patients (ISS > 16) were included (<60 years, = 49; ≥60 years, = 49; ≥60 years, = 11). Serum TIMP-1 and MMP-9 levels showed a highly significant serum dynamic in young and old polytrauma patients ( < 0.001). Patients ≥ 60 years showed significantly higher overall TIMP-1 levels ( < 0.001). Patients ≥ 60 years showed significantly higher overall TIMP-1 levels ( = 0.008). TIMP-1 levels showed a significant maximum after 72 h in the older study population. MMP-9 levels were nonsignificantly higher during the whole observational period in older polytrauma patients when compared to younger patients.
The posttraumatic immune response is characterized by significantly higher TIMP-1 levels in older polytrauma patients. This significant association between TIMP-1 levels and patients' age indicates a more extensive immune dysregulation following major trauma in older adults.
多发伤患者经常遭受创伤后免疫系统不稳定，这对进一步的临床发展有很大影响。最近，年龄增长被确定为导致重大创伤后不良结局的一个孤立危险因素。严重损伤后急性炎症发生率和强度增加表明，失代偿性炎症可能导致老年人创伤后发病率和死亡率升高。在之前的全基因组 mRNA 分析中发现，MMP-9 和 TIMP-1 在创伤后免疫紊乱中起着重要作用。
本研究旨在评估老年和年轻多发伤患者血清蛋白动力学的差异。
在创伤后 90 分钟内立即抽取血样，随后分别在 6、12、24、48 和 72 小时后抽取。采用 ELISA 法测定 TIMP-1 和 MMP-9 的血清水平。根据 60 岁的截止值将年龄组分为两组。
纳入 60 例多发伤患者（ISS>16）（<60 岁，n=49；≥60 岁，n=49；≥60 岁，n=11）。年轻和老年多发伤患者的血清 TIMP-1 和 MMP-9 水平均呈现高度显著的血清动力学变化（<0.001）。≥60 岁的患者总 TIMP-1 水平明显升高（<0.001）。≥60 岁的患者总 TIMP-1 水平明显升高（=0.008）。在老年患者中，TIMP-1 水平在 72 小时后达到显著最大值。与年轻患者相比，老年多发伤患者在整个观察期内 MMP-9 水平均升高，但无统计学意义。
多发伤后免疫反应的特点是老年多发伤患者 TIMP-1 水平显著升高。TIMP-1 水平与患者年龄之间的显著相关性表明，老年人在遭受重大创伤后，免疫失调更为严重。
