Pietsch J B, Meakins J L, MacLean L D
Surgery. 1977 Sep;82(3):349-55.
Delayed hypersensitivity skin testing was performed on 520 surgical patients. Significantly higher incidences of sepsis and mortality (p less than 0.001) were found in the abnormal patients as compared to normal responders in the preoperative (322 patients), postoperative and post-trauma (115 patients), and nonoperative (83 patients) groups. Sequential testing in individual patients was of even greater prognostic value. Of the 177 patients who either remained normal or whose responses became normal, the sepsis rate was 10.1%, and the mortality rate was 8.4%. However, a sepsis rate of 57.6% and a 78% mortality rate were found in those patients who developed abnormal responses or whose responses did not improve. Cancer and increased age (older than 80 years) did not account for the incidence of anergy and relative anergy. The mortality rate was higher in the cancer group. Anergy and relative anergy were found to be associated with malnutrition, sepsis, shock, and trauma. In the clinical setting, effective treatment of these associated conditions, especially the maintenance of body cell mass by the use of total parenteral nutrition, was associated with reversal of the anergic state and an improved prognosis.
对520例外科手术患者进行了迟发型超敏皮肤试验。术前（322例患者）、术后和创伤后（115例患者）以及非手术（83例患者）组中，与正常反应者相比，异常患者的败血症发生率和死亡率显著更高（p小于0.001）。对个体患者进行连续检测具有更大的预后价值。在177例反应保持正常或恢复正常的患者中，败血症发生率为10.1%，死亡率为8.4%。然而，在那些反应异常或未改善的患者中，败血症发生率为57.6%，死亡率为78%。癌症和高龄（80岁以上）并不能解释无反应性和相对无反应性的发生率。癌症组的死亡率更高。发现无反应性和相对无反应性与营养不良、败血症、休克和创伤有关。在临床环境中，有效治疗这些相关病症，尤其是通过使用全胃肠外营养维持身体细胞量，与无反应状态的逆转和预后改善有关。
