Grob P, Holch M, Fierz W, Glinz W, Geroulanos S
Department of Medicine, University Hospital, Zurich, Switzerland.
Pediatr Infect Dis J. 1988 May;7(5 Suppl):S37-42.
The posttrauma immunodeficiency syndrome and the related postsurgery immunodeficiency syndrome are essential for the infections often occurring after polytrauma and major surgery. Data are given here showing that after such events the levels of immunoglobulins; the complement factors C3C, C4 and C Factor B; and the numbers of circulating lymphocytes and of the subpopulations CD3, CD4, CD8 and natural killer cells as well as the stimulatory capacity of mononuclear cells to mitogen fall; while the levels of acute phase proteins, neopterin and interleukin 2 receptors and the spontaneous uptake of thymidine by mononuclear cells become augmented. Extent and duration of these changes and the rate of subsequent infections depend on the extent and kind of surgery (minor, major, clean, contaminated). However, crucial factors of the posttrauma and postsurgery immunodeficiency syndromes are not yet elucidated and relevant predictive parameters for infections are not at hand. These are essential prerequisites to initiate future immunomodulatory measures which should be added to the use of intravenous immunoglobulins yielding so far distinct but limited benefits for the prevention of infections after polytrauma and major surgery.
创伤后免疫缺陷综合征及相关的术后免疫缺陷综合征是多发伤和大手术后常发生感染的重要因素。本文给出的数据表明，在这些事件发生后，免疫球蛋白水平、补体因子C3C、C4和B因子水平、循环淋巴细胞及CD3、CD4、CD8亚群和自然杀伤细胞数量以及单核细胞对有丝分裂原的刺激能力下降；而急性期蛋白、新蝶呤和白细胞介素2受体水平以及单核细胞对胸腺嘧啶核苷的自发摄取增加。这些变化的程度和持续时间以及随后感染的发生率取决于手术的范围和类型（小手术、大手术、清洁手术、污染手术）。然而，创伤后和术后免疫缺陷综合征的关键因素尚未阐明，也没有可用于感染的相关预测参数。这些是启动未来免疫调节措施的基本前提，目前静脉注射免疫球蛋白在预防多发伤和大手术后感染方面虽有明显但有限的益处，而免疫调节措施应在此基础上进一步应用。
