Abraham E
Department of Medicine, UCLA Medical Center 90024.
New Horiz. 1993 Feb;1(1):28-36.
Important alterations in T- and B-cell function affecting host defense and resistance to infection are found in critically ill patients and in experimental models of critical illness. In the setting of critical illness, injury, and blood loss, both T and B cells are affected, producing a relatively immunocompromised state where infection is more likely to occur, and where the ability to control the infection is lessened. Alterations in T-cell activation and cytokine production are frequently associated with hemorrhage and trauma. Injury and blood loss result in activation of CD8+ T-cell populations capable of altering bacterial antigen-specific B-cell repertoires and of suppressing the function of other T cells. The production of antibodies directed to bacterial antigens, and required for protection against extracellular bacterial infection, is diminished in models of critical illness, primarily because of disappearance of bacterial antigen-specific B-cell clonal precursors at systemic, pulmonary, and intestinal sites. Correction of the alterations in T- and B-cell function associated with critical illness would be expected to reduce the frequency of nosocomial infections in the ICU. In addition, maintenance of immunocompetence in critically ill patients will permit improved outcome should infection occur.
在重症患者以及危重病实验模型中发现了T细胞和B细胞功能的重要改变，这些改变影响宿主防御和抗感染能力。在危重病、损伤和失血的情况下，T细胞和B细胞均受到影响，从而产生相对免疫功能低下的状态，在此状态下感染更易发生，且控制感染的能力减弱。T细胞活化和细胞因子产生的改变常与出血和创伤相关。损伤和失血导致CD8 + T细胞群体活化，这些细胞能够改变细菌抗原特异性B细胞库，并抑制其他T细胞的功能。在危重病模型中，针对细菌抗原且对抵御细胞外细菌感染至关重要的抗体产生减少，这主要是因为全身、肺部和肠道部位细菌抗原特异性B细胞克隆前体消失。预期纠正与危重病相关的T细胞和B细胞功能改变将降低重症监护病房医院感染的发生率。此外，维持重症患者的免疫能力将在感染发生时改善预后。
