多发伤患者免疫功能抑制相关机制的研究  

Mechanisms of immunosuppression in patients with multiple trauma

作　　者：元智昊[1] 闫红[1] 李玉堂[1] 林辉[1] 郭春文[1] 

机构地区：[1]解放军第180医院重症医学科,福建泉州362000

出　　处：《解放军医学院学报》2016年第8期842-844,共3页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨多发伤患者免疫功能抑制相关机制。方法收集我院2014年1月-2015年1月55例多发性创伤患者作为研究组,30例接受体检的正常人作为对照组。患者入院治疗1周后,抽取肘静脉血。采用速率散射免疫比浊法测定对照组和研究组血清中补体系统活化产物C3a、C4a、C5a和C5b-9水平;采用流式细胞术检测对照组和研究组外周血中间充质干细胞(mesenchymal stem cell,MSC)和调节性T细胞(regutatory T cell,Treg)含量;采用酶联免疫法(ELISA)检测对照组和研究组血清中IFN-γ、TGF-β和IL-10水平。结果研究组血清C3a、C4a和C5b-9分别为(0.65±0.16)g/L,(0.18±0.06)g/L,(10.87±1.78)ng/L,对照组为(1.25±0.31)g/L,(0.32±0.18)g/L,(26.38±2.28)ng/L,差异有统计学意义(P<0.05);研究组C5a(185.56±3.45)μg/ml,对照组(131.58±12.15)μg/ml,差异有统计学意义(P<0.05)。研究组外周血中MSC(3.98±0.25)%,Treg细胞含量(4.46±0.35)%,对照组为(2.58±0.12)%、(3.12±0.23)%,差异有统计学意义(P<0.05);研究组血清IFN-γ、TGF-β和IL-10分别为(15.27±0.75)ng/ml、(10.08±0.65)ng/ml、(12.45±0.38)ng/ml,对照组为(8.74±0.51)ng/ml、(5.29±0.47)ng/ml、(7.96±0.52)ng/ml,差异有统计学意义(P<0.05)。结论多发性创伤患者血清中C3a、C4a和C5b-9显著降低,补体系统的活性降低,患者处于免疫抑制状态,外周血中含有大量MSC和Treg细胞,血清中含有大量的免疫抑制因子如IFN-γ、TGF-β和IL-10,可显著抑制创伤后免疫反应。Objective To investigate the mechanisms of immunosuppression in patients with multiple trauma. Methods From January 2014 to January 2015, 55 patients with multiple trauma were enrolled as research group, and 30 healthy individuals as control group. One week after hospitalization, the blood sample was collected and stored for analysis. The serum level of C3 a, C4 a, C5 a and C5b-9（the active products of complement system） of patients in control group and research group were measured by rate scattering immune turbidimetry, the amount of mesenchymal stem cells and Tregs in periphery blood were detected by flow cytometry, and the serum IFN-γ, TGF-β and IL-10 level were tested by ELISA. Results The C3 a, C4 a and C5b-9 levels of the research group were significantly lower than those of control group [（0.65±0.16） g/L vs（1.25±0.31） g/L,（0.18±0.06） g/L vs（0.32±0.18） g/L,（10.87±1.78） ng/L vs（26.38±2.28） ng/L, P〈 0.05], while the C5 a level in serum in research group was significantly higher than that of control group [（185.56±3.45）μg/m L vs（131.58±12.15）μg/m L, P〈0.05]. The results of flow cytometry indicated that the amount of MSC and Tregs of the research group were higher than those of the control group [（3.98±0.25）% vs（2.58±0.12）%,（4.46±0.35）% vs（3.12±0.23）%, P 0.05]. The levels of IFN-γ, TGF-β and IL-10 in research group were significantly higher than those of control group [（15.27±0.75） ng/ml vs（8.74±0.51） ng/ml,（10.08±0.65） ng/ml vs（5.29±0.47） ng/ml,（12.45±0.38）ng/ml vs（7.96±0.52） ng/ml, P〈 0.05]. Conclusion Patients with multiple trauma has a low serum level of complement gystem active products such as C3 a, C4 a and C5b-9. The low activity of complement system results in a state of immunosuppression, the periphery blood of the patients contains large amount of immunosuppressive cells such as MSC and Tregs, and the serum level of immuno-suppressors such as IFN-γ, TGF-β and IL-10 increases obviously leading t

关 键 词：补体系统 多发性创伤 免疫抑制 

分 类 号：R641[医药卫生—外科学]