From the Department of Surgery, Faculty of Health Sciences (M.M., D.K.), Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand Medical School, Parktown, Johannesburg; National Health Laboratory Service, School of Pathology (S.P.), Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Gauteng (S.P.); and Faculty of Health Sciences (F.P.), Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand Medical School, Parktown, Johannesburg, South Africa.
J Trauma Acute Care Surg. 2021 Mar 1;90(3):565-573. doi: 10.1097/TA.0000000000003043.
The detrimental effect of trauma on the immune system has been a subject of interest for decades. The gut-associated lymphoid tissue (GALT) of the bowel that encompasses different lymphocyte subpopulations may be an important pillar of human immunity in the context of trauma. Neither the short-term histological trauma-induced changes in the GALT nor its impact on the outcome after trauma surgery has been investigated.
This prospective, longitudinal proof-of-concept study included patients who required damage-control surgery after abdominal gunshot wounds with small bowel involvement. Bowel specimens were obtained during the index and relook operations, and the T-lymphocytic quantity therein was analyzed via immunohistochemistry. We scrutinized how the lymphocyte structure and numbers of the GALT altered, and whether the extent and nature of these changes had an impact on the postoperative outcome with regard to septic and surgical complications.
A total of 31 damage-control patients were recruited for the study. The main histological changes between the index and relook specimen was a shift of CD8+ T cells from the lamina propria (LP) into the epithelium and a decrease of T lymphocytes in the LP. The significant increase of the intraepithelial CD8+ T cells was associated with a more extensive enterocyte apoptosis, and correlated significantly, positively with the number of postoperative septic complications.
Our data support that trauma induces an immune cell-driven impairment of the intestinal epithelium, as well as an increased apoptosis of lymphocytes in the LP, which is associated with a worse clinical outcome. The underlying mechanism suggests that a therapeutic approach to minimize apoptosis in the intestine may impact the outcome of severely injured trauma patients.
Therapeutic/care/management, level lV.
创伤对免疫系统的有害影响已成为数十年来的研究课题。肠道相关的淋巴组织（GALT）包含不同的淋巴细胞亚群，可能是创伤背景下人类免疫的重要支柱。尚未研究 GALT 短期组织学创伤诱导变化及其对创伤手术后结果的影响。
这项前瞻性、纵向概念验证研究纳入了因腹部枪击伤合并小肠受累而需要进行损伤控制性手术的患者。在指数和再次探查手术期间获取肠标本，并通过免疫组织化学分析其中的 T 淋巴细胞数量。我们仔细观察 GALT 的淋巴细胞结构和数量如何变化，以及这些变化的程度和性质是否对术后发生脓毒症和手术并发症的结果产生影响。
共有 31 名损伤控制性患者入组本研究。指数和再次探查标本之间的主要组织学变化是 CD8+T 细胞从固有层（LP）转移到上皮细胞，以及 LP 中的 T 淋巴细胞减少。上皮内 CD8+T 细胞的显著增加与更广泛的肠细胞凋亡有关，与术后脓毒症并发症的数量呈显著正相关。
我们的数据支持创伤诱导免疫细胞驱动的肠上皮损伤，以及 LP 中淋巴细胞凋亡增加，这与更差的临床结果相关。潜在的机制表明，一种旨在最大限度减少肠道细胞凋亡的治疗方法可能会影响严重创伤患者的结局。
治疗/护理/管理，四级。
