目的对比老年人与青中年人严重创伤后免疫指标与炎性介质的变化,探讨老年人群创伤后免疫抑制的程度与变化特征.方法31例年龄＞65岁,平均(72.4±7.6)岁,ISS评分＞20分,平均(27±5)分的老年创伤病人与中青年创伤病人[平均年龄(30....目的对比老年人与青中年人严重创伤后免疫指标与炎性介质的变化,探讨老年人群创伤后免疫抑制的程度与变化特征.方法31例年龄＞65岁,平均(72.4±7.6)岁,ISS评分＞20分,平均(27±5)分的老年创伤病人与中青年创伤病人[平均年龄(30.6±16.2)岁,平均ISS评分(29±6)分]配对分组,在来诊后和伤后2、4、6、8 d采用流式细胞术连续检测T细胞亚群比例和CD14+单核细胞人类白细胞抗原-DR(HLA-DR)表达,同时观察免疫球蛋白IgA、IgG、IgM,补体C3、C4,C反应蛋白(CRP)和促炎介质肿瘤坏死因子(TNF-α)、白介素6(IL-6),白介素10(IL-10)血浆水平.结果老年组伤后TNF-α、IL-6、IL-10低于青中年组,但持续上升时间延长,在6～8 d后IL-10血浆浓度已高于青中年组.老年组伤后4～8 d Th1/Th2比值下降明显,CD14+HLA-DR表达下调.结论老年人创伤后发生的免疫抑制比青中年人群更显著,表现为单核-T淋巴细胞免疫功能受抑,而抗炎细胞因子清除不利可能是导致这一免疫功能紊乱的重要原因.展开更多
This study examined the effect of intensive insulin therapy on immune function and inflammatory factors at the early phase after severe trauma. At day 1, 3, 5, 7 after admission, subsets of CD4＋ helper T lymphocytes ...This study examined the effect of intensive insulin therapy on immune function and inflammatory factors at the early phase after severe trauma. At day 1, 3, 5, 7 after admission, subsets of CD4＋ helper T lymphocytes （Th1/Th2） and human leukocyte antigen （HLA）-DR expression on CD14＋ monocytes were flow cytometrically measured. Levels of cytokines, including tumor necrosis factor-alpha （TNF-α）, interleukin-6 （IL-6）, interleukin-10 （IL-10） and other immunity markers, such as IgA, IgG, IgM, C3, C4 and C reaction protein （CRP） were examined in two groups. The results showed that TNF-α, IL-6 and CRP levels in the intensive insulin therapy group were significantly lower than those in the conventional therapy group, whereas IL-10 levels were substantially increased after intensive insulin therapy. C3 level at day 3, 5, 7 and C4 levels at day 5, 7 were lower in the intensive therapy group than in the conventional therapy group. Th1/Th2 ratios decreased gradually over time in both groups, and were much lower at day 3, 5, 7 in intensive therapy group. There were significant differences among day 3 to day 7 after admission in HLA-DR expression in CD14＋ monocytes. It was concluded that the intensive insulin therapy could decrease pro-inflammatory cytokines and increase anti-inflammatory cytokines in the elderly suffering from severe trauma, at the same time, with complement recovery being delayed. Moreover, intensive insulin therapy promoted immune suppression and, therefore, measures need be taken to address the issue.展开更多
文摘目的对比老年人与青中年人严重创伤后免疫指标与炎性介质的变化,探讨老年人群创伤后免疫抑制的程度与变化特征.方法31例年龄＞65岁,平均(72.4±7.6)岁,ISS评分＞20分,平均(27±5)分的老年创伤病人与中青年创伤病人[平均年龄(30.6±16.2)岁,平均ISS评分(29±6)分]配对分组,在来诊后和伤后2、4、6、8 d采用流式细胞术连续检测T细胞亚群比例和CD14+单核细胞人类白细胞抗原-DR(HLA-DR)表达,同时观察免疫球蛋白IgA、IgG、IgM,补体C3、C4,C反应蛋白(CRP)和促炎介质肿瘤坏死因子(TNF-α)、白介素6(IL-6),白介素10(IL-10)血浆水平.结果老年组伤后TNF-α、IL-6、IL-10低于青中年组,但持续上升时间延长,在6～8 d后IL-10血浆浓度已高于青中年组.老年组伤后4～8 d Th1/Th2比值下降明显,CD14+HLA-DR表达下调.结论老年人创伤后发生的免疫抑制比青中年人群更显著,表现为单核-T淋巴细胞免疫功能受抑,而抗炎细胞因子清除不利可能是导致这一免疫功能紊乱的重要原因.
基金supported by a grant from the National Natural Sciences Foundation of China(No.30700869)
文摘This study examined the effect of intensive insulin therapy on immune function and inflammatory factors at the early phase after severe trauma. At day 1, 3, 5, 7 after admission, subsets of CD4＋ helper T lymphocytes （Th1/Th2） and human leukocyte antigen （HLA）-DR expression on CD14＋ monocytes were flow cytometrically measured. Levels of cytokines, including tumor necrosis factor-alpha （TNF-α）, interleukin-6 （IL-6）, interleukin-10 （IL-10） and other immunity markers, such as IgA, IgG, IgM, C3, C4 and C reaction protein （CRP） were examined in two groups. The results showed that TNF-α, IL-6 and CRP levels in the intensive insulin therapy group were significantly lower than those in the conventional therapy group, whereas IL-10 levels were substantially increased after intensive insulin therapy. C3 level at day 3, 5, 7 and C4 levels at day 5, 7 were lower in the intensive therapy group than in the conventional therapy group. Th1/Th2 ratios decreased gradually over time in both groups, and were much lower at day 3, 5, 7 in intensive therapy group. There were significant differences among day 3 to day 7 after admission in HLA-DR expression in CD14＋ monocytes. It was concluded that the intensive insulin therapy could decrease pro-inflammatory cytokines and increase anti-inflammatory cytokines in the elderly suffering from severe trauma, at the same time, with complement recovery being delayed. Moreover, intensive insulin therapy promoted immune suppression and, therefore, measures need be taken to address the issue.
