Schreiber M A, Pusateri A E, Veit B C, Smiley R A, Morrison C A, Harris R A
Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas 79920-5001, USA.
J Trauma. 1998 Oct;45(4):692-7; discussion 697-9. doi: 10.1097/00005373-199810000-00009.
Pneumococcal vaccination after splenectomy for trauma decreases the incidence of overwhelming postsplenectomy infection. The optimal timing of vaccination has not been established. This study was conducted to determine whether timing of vaccination after splenectomy affects antibody response or survival after pneumococcal challenge.
Sprague-Dawley rats were used for all experiments. Control rats (n=30) were divided into three equal groups and underwent splenectomy followed by sham vaccination 1, 7, or 42 days after splenectomy. Treated rats (n=66) were divided into three equal groups and underwent splenectomy followed by vaccination with polyvalent pneumococcal vaccine 1, 7, or 42 days after splenectomy. All rats then underwent intraperitoneal Streptococcus pneumoniae inoculation with the predetermined lethal dose for 50% of the population 10 days after vaccination. Rats were observed for a 72-hour period after inoculation, and mortality was recorded. Immunoglobulin G and immunoglobulin M antibody titers were determined before vaccination and before inoculation to determine antibody response.
Mortality was greater in the control group than in the treatment group (21 of 30 [70%] vs. 2 of 64 [3%]; p < 0.01). There were no differences in mortality within either the control group (1 day, 6 of 10; 7 days, 7 of 10; 42 days, 8 of 10; p=0.62) or the treatment group (1 day, 0 of 21; 7 days, 0 of 21; 42 days, 2 of 22; p=0.14). Immunoglobulin G and immunoglobulin M antibody responses were greater in vaccinated than in nonvaccinated rats. There was no effect of timing of vaccination on antibody response.
Pneumococcal vaccine reduces mortality from postsplenectomy infection. Timing of vaccination after splenectomy does not affect survival from a pneumococcal challenge or antibody response in rats. This study supports the practice of administering vaccine within 24 hours of splenectomy when vaccine cannot be administered before surgery.
创伤性脾切除术后接种肺炎球菌疫苗可降低脾切除术后暴发性感染的发生率。最佳接种时间尚未确定。本研究旨在确定脾切除术后接种疫苗的时间是否会影响抗体反应或肺炎球菌攻击后的存活率。
所有实验均使用Sprague-Dawley大鼠。将对照大鼠（n = 30）分为三组，每组数量相等，进行脾切除，然后在脾切除术后1、7或42天进行假接种。将处理大鼠（n = 66）分为三组，每组数量相等，进行脾切除，然后在脾切除术后1、7或42天接种多价肺炎球菌疫苗。所有大鼠在接种疫苗10天后腹腔注射预定致死剂量的肺炎链球菌，该剂量对50%的大鼠群体致死。接种后观察大鼠72小时，并记录死亡率。在接种疫苗前和接种前测定免疫球蛋白G和免疫球蛋白M抗体滴度，以确定抗体反应。
对照组的死亡率高于治疗组（30只中的21只[70%]对64只中的2只[3%]；p < 0.01）。对照组（1天，10只中的6只；7天，10只中的7只；42天，10只中的8只；p = 0.62）或治疗组（1天，21只中的0只；7天，21只中的0只；42天，22只中的2只；p = 0.14）内的死亡率无差异。接种疫苗的大鼠的免疫球蛋白G和免疫球蛋白M抗体反应高于未接种疫苗的大鼠。接种时间对抗体反应没有影响。
肺炎球菌疫苗可降低脾切除术后感染的死亡率。脾切除术后接种疫苗的时间不影响大鼠在肺炎球菌攻击后的存活率或抗体反应。本研究支持在无法在手术前接种疫苗时，在脾切除术后24小时内接种疫苗的做法。
