Vollrath Jan Tilmann, Klingebiel Felix, Bläsius Felix Marius, Greven Johannes, Bolierakis Eftychios, Janicova Andrea, Dunay Ildiko Rita, Hildebrand Frank, Marzi Ingo, Relja Borna
Department of Trauma, Hand and Reconstructive Surgery, Goethe University, Frankfurt, Germany.
Department of Trauma, University of Zurich, Universitätsspital Zurich, Zurich, Switzerland.
Front Med (Lausanne). 2021 Apr 6;8:645589. doi: 10.3389/fmed.2021.645589. eCollection 2021.
Polytraumatized patients undergo a strong immunological stress upon insult. Phagocytes (granulocytes and monocytes) play a substantial role in immunological defense against bacteria, fungi and yeast, and in the clearance of cellular debris after tissue injury. We have reported a reduced monocytes phagocytic activity early after porcine polytrauma before. However, it is unknown if both phagocyte types undergo those functional alterations, and if there is a pathogen-specific phagocytic behavior. We characterized the phagocytic activity and capacity of granulocytes and monocytes after polytrauma. Eight pigs () underwent polytrauma consisting of lung contusion, liver laceration, tibial fracture and hemorrhagic shock with fluid resuscitation and fracture fixation with external fixator. Intensive care treatment including mechanical ventilation for 72 h followed. Phagocytic activity and capacity were investigated using an whole blood stimulation phagocytosis assays before trauma, after surgery, 24, 48, and 72 h after trauma. Blood samples were stimulated with Phorbol-12-myristate-13-acetate and incubated with FITC-labeled or for phagocytosis assessment by flow cytometry. Early polytrauma-induced significant increase of granulocytes and monocytes declined to baseline values within 24 h. Percentage of -phagocytizing granulocytes significantly decreased after polytrauma and during further intensive care treatment, while their capacity significantly increased. Interestingly, both granulocytic phagocytic activity and capacity of significantly decreased after trauma, although a recovery was observed after 24 h and yet was followed by another decrease. The percentage of -phagocytizing granulocytes significantly increased after 24 h, while their impaired capacity after surgery and 72 h later was detected. Monocytic -phagocytizing percentage did not change, while their capacity increased after 24-72 h. After a significant decrease in -phagocytizing monocytes after surgery, a significant increase after 24 and 48 h was observed without capacity alterations. No significant changes in -phagocytizing monocytes occurred, but their capacity dropped 48 and 72 h. Phagocytic activity and capacity of granulocytes and monocytes follow a different pattern and significantly change within 72 h after polytrauma. Both phagocytic activity and capacity show significantly different alterations depending on the pathogen strain, thus potentially indicating at certain and possibly more relevant infection causes after polytrauma.
多发伤患者在受伤后会遭受强烈的免疫应激。吞噬细胞（粒细胞和单核细胞）在抵抗细菌、真菌和酵母的免疫防御以及组织损伤后清除细胞碎片过程中发挥着重要作用。我们之前报道过猪多发伤后早期单核细胞吞噬活性降低。然而，尚不清楚这两种吞噬细胞类型是否都会发生这些功能改变，以及是否存在病原体特异性吞噬行为。我们对多发伤后粒细胞和单核细胞的吞噬活性及能力进行了表征。八头猪接受了由肺挫伤、肝裂伤、胫骨骨折和失血性休克组成的多发伤，随后进行液体复苏并用外固定器固定骨折。接着进行了包括机械通气72小时的重症监护治疗。在创伤前、手术后、创伤后24、48和72小时，使用全血刺激吞噬细胞试验研究吞噬活性和能力。用佛波酯 - 12 - 肉豆蔻酸酯 - 13 - 乙酸盐刺激血样，并与异硫氰酸荧光素标记的或一起孵育，通过流式细胞术评估吞噬作用。多发伤早期诱导的粒细胞和单核细胞显著增加在24小时内降至基线值。多发伤后及进一步的重症监护治疗期间，吞噬的粒细胞百分比显著下降，而其能力显著增加。有趣的是，创伤后粒细胞的吞噬活性和吞噬的能力均显著下降，尽管在24小时后观察到恢复，但随后又再次下降。吞噬的粒细胞百分比在24小时后显著增加，而在手术后及72小时后检测到其能力受损。单核细胞吞噬的百分比没有变化，而其能力在24 - 72小时后增加。手术后吞噬的单核细胞显著减少后，在24和48小时后观察到显著增加，且能力无改变。吞噬的单核细胞没有显著变化，但其能力在48和72小时下降。多发伤后72小时内，粒细胞和单核细胞的吞噬活性和能力遵循不同模式且发生显著变化。吞噬活性和能力根据病原体菌株显示出显著不同的改变，因此可能表明多发伤后某些且可能更相关的感染原因。
