从创伤到慢性病：了解多发伤患者慢性并发症的发生率及早期免疫变化

From trauma to chronicity: Understanding the incidence and early immune changes of chronic complications in polytrauma patients.

作者信息

Zhang Cong, Chen Deng, Wan Qian, Yin Gang, Liu Yang, Luo Jialiu, Chen Shunyao, Lin Zhiqiang, Gu Shuaipeng, Li Hui, Chang Teding, Dong Liming, Zhang Peidong, Tang Zhaohui

机构信息

Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Department of Trauma Surgery, Trauma Center, Xiantao First people's Hospital, Xiantao, China.

出版信息

Sci Prog. 2024 Oct-Dec;107(4):368504241305901. doi: 10.1177/00368504241305901.

DOI:10.1177/00368504241305901

PMID:39686584

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11653341/

Abstract

OBJECTIVE

Polytrauma is a complex condition associated with poor outcomes and high mortality rates resulting from severe damage and complicated complications. This study sought to ascertain the incidence of chronic complications in polytrauma patients, as well as the early immune changes and risk factors.

METHODS

A multicenter, prospective and observational cohort study was conducted at the emergency surgery or traumatic intensive care unit (TICU) of the Advanced Trauma Center from August 2020 to July 2023. A total of 2033 consecutive trauma patients were included in the study. In the first 1, 7, and 14 days after admission, flow cytometry and immunoassay kits were used to examine cytokine release and lymphocyte count.

RESULTS

Trauma patients were reported 33.8% (687/2033) chronic complication rates, with monotrauma patients reported 8.1% (55/683) and polytrauma patients reported 59.4% (802/1350). And the four most frequent chronic complications in polytrauma patients were chronic musculoskeletal pain (30.4%), post-traumatic osteoarthritis (27.2%), chronic wound (21.6%), and chronic lung injury (14.1.%) .There were significant differences in lymphocyte ratios and cytokine levels, at 1, 7, and 14 day of admission between chronic complication groups (CCP) and not chronic complication groups (N-CCP) in polytrauma. Polytrauma patients with characteristics of higher ratio of Ts ratio (95% CI: 2.01-6.21), Treg (95% CI: 1.12-5.43) and level of IL-6 (95% CI: 1.22-4.43), TNF-α (95% CI: 1.05-3.83), IL-10 (95% CI: 2.01-6.84) were found to have a higher likelihood of experiencing a chronic complication. Conversely, a higher ratio of Tc (95% CI: 0.53-0.86), Th (95% CI: 0.64-0.95) and Th/Ts (95% CI: 0.21-0.64) were identified as independent protective factors against a chronic complication event.

CONCLUSION

Polytrauma patients exhibit a notable prevalence of chronic complications. Some immune and inflammatory indicators can be observed early in combination after injury to predict the risk of chronic complications after polytrauma.

摘要

目的

多发伤是一种复杂的病症，由于严重损伤和复杂并发症导致预后不良和死亡率高。本研究旨在确定多发伤患者慢性并发症的发生率，以及早期免疫变化和危险因素。

方法

于2020年8月至2023年7月在高级创伤中心的急诊外科或创伤重症监护病房（TICU）进行了一项多中心、前瞻性观察队列研究。共有2033例连续创伤患者纳入研究。在入院后的第1、7和14天，使用流式细胞术和免疫分析试剂盒检测细胞因子释放和淋巴细胞计数。

结果

创伤患者慢性并发症发生率为33.8%（687/2033），其中单处创伤患者为8.1%（55/683），多发伤患者为59.4%（802/1350）。多发伤患者最常见的四种慢性并发症为慢性肌肉骨骼疼痛（30.4%）、创伤后骨关节炎（27.2%）、慢性伤口（21.6%）和慢性肺损伤（14.1%）。多发伤患者慢性并发症组（CCP）和非慢性并发症组（N-CCP）在入院第1、7和14天的淋巴细胞比例和细胞因子水平存在显著差异。多发伤患者中，Ts比例（95%CI：2.01-6.21）、调节性T细胞（Treg，95%CI：1.12-5.43）以及白细胞介素-6（IL-6，95%CI：1.22-4.43）、肿瘤坏死因子-α（TNF-α，95%CI：1.05-3.83）、IL-10（95%CI：2.01-6.84）水平较高者发生慢性并发症的可能性更大。相反，细胞毒性T细胞（Tc，95%CI：0.53-0.86）、辅助性T细胞（Th，95%CI：0.64-0.95）以及Th/Ts（95%CI：0.21-0.64）比例较高被确定为预防慢性并发症事件的独立保护因素。