Cocks R A, Chan T Y, Rainer T H
Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, Peoples' Republic of China.
J Trauma. 1998 Jul;45(1):1-6. doi: 10.1097/00005373-199807000-00001.
Infection and multiple organ failure remain the principal causes of late mortality after trauma despite advances in the resuscitation of injured patients. Because a better understanding of postinjury leukocyte trafficking is essential to the development of possible therapeutic measures aimed at preventing these complications, we have performed a study of one factor in the early posttrauma endothelial adhesion behavior of monocytes, lymphocytes, and neutrophils: their cell surface expression of L-selectin (CD62L). We have also studied the plasma levels of soluble L-selectin in these patients.
Two venous blood samples were taken from each of 41 trauma patients at median times of 1 and 20 hours after injury. The study group included 16 patients with major (Injury Severity Score (ISS) > or = 16), 17 with moderate (ISS = 9-15), and 8 with minor (ISS < 9) trauma. Cell surface L-selectin was measured on leukocyte subsets by staining with specific fluorescent-labeled monoclonal antibodies to CD62L and using flow cytometry. Both the percentage of cells expressing the molecule and the mean channel fluorescence were measured. Levels of soluble L-selectin were measured in the plasma, sampled concurrently, by enzyme-linked immunosorbent assay.
Monocytes, lymphocytes, and neutrophils all showed an early increase in cell surface L-selectin expression as measured by mean channel fluorescence (p < 0.0001, p < 0.001, and p < 0.0001, respectively), and this persisted in later samples taken at a median 20 hours after injury (p < 0.0001,p < 0.0001, and p < 0.01). Only monocytes showed an increased percentage of cells expressing the molecule in the early phase (p < 0.02), and this remained in the later phase (p < 0.001). Monocytes also showed a further significant increase in mean channel fluorescence (p < 0.02) between the two periods. No significant changes in levels of plasma soluble L-selectin were found at either stage.
An increase in the expression of L-selectin on each of three leukocyte populations has been demonstrated in the early phase after trauma. This would tend to promote rolling behavior of leukocytes and increase their contact with the vascular endothelium. There were marked differences in the later responses of the three populations, which may represent differential control of their behavior.
尽管在创伤患者的复苏方面取得了进展，但感染和多器官功能衰竭仍然是创伤后晚期死亡的主要原因。由于更好地了解伤后白细胞的迁移对于制定旨在预防这些并发症的可能治疗措施至关重要，我们对单核细胞、淋巴细胞和中性粒细胞创伤后早期内皮黏附行为中的一个因素进行了研究：它们细胞表面L-选择素（CD62L）的表达。我们还研究了这些患者血浆中可溶性L-选择素的水平。
从41例创伤患者中，在伤后1小时和20小时的中位时间分别采集两份静脉血样本。研究组包括16例重伤患者（损伤严重度评分（ISS）≥16）、17例中度伤患者（ISS = 9 - 15）和8例轻伤患者（ISS < 9）。通过用针对CD62L的特异性荧光标记单克隆抗体染色并使用流式细胞术，测定白细胞亚群表面的L-选择素。同时测量表达该分子的细胞百分比和平均通道荧光。通过酶联免疫吸附测定法测定同期采集的血浆中可溶性L-选择素的水平。
通过平均通道荧光测量，单核细胞、淋巴细胞和中性粒细胞在细胞表面L-选择素表达上均显示早期增加（分别为p < 0.0001、p < 0.001和p < 0.0001），并且在伤后20小时的中位时间采集的后期样本中这种增加持续存在（p < 0.0001、p < 0.0001和p < 0.01）。只有单核细胞在早期显示表达该分子的细胞百分比增加（p < 0.02），并且在后期仍然如此（p < 0.001）。单核细胞在两个时期之间平均通道荧光也进一步显著增加（p < 0.02）。在两个阶段均未发现血浆可溶性L-选择素水平有显著变化。
已证实在创伤后的早期阶段，三种白细胞群体表面的L-选择素表达均增加。这将倾向于促进白细胞的滚动行为并增加它们与血管内皮的接触。这三种群体后期的反应存在明显差异，这可能代表了对它们行为的不同控制。
