创伤患者血清免疫抑制物与预后的关系研究

RelationshipbetweenSerumAbnormalProteinfromInjuredPatientsandPrognosisofthePatients

目的：通过临床机械性创伤患者血清的分析，探讨血清异常蛋白与创伤患者预后的关系．方法：收集了２６例创伤患者血清，按创伤严重度评分将患者分为轻度（ＩＳＳ＜１６），中度（ＩＳＳ１６～２５），重度（ＩＳＳ≥２５）三组；分别检测了其血清对正常人外周血单个核细胞（ＰＢＭＣ）转化和ＩＬ－２产生的影响；观测了血清抑制性、创伤严重度评分与患者预后的关系．结果：随着创伤严重度增加，血清的免疫抑制性亦明显增强，ＰＢＭＣ转化降低；ＩＬ－２产生减少；有１０例患者血清可检测出明显的异常蛋白（分子量约为９０００），创伤愈重，异常蛋白出现频率亦愈高，检出异常蛋白者ＩＳＳ明显高于未检出异常蛋白患者（２３／１４．６）．结论：机械性创伤患者血清中可检出具有免疫抑制性的异常蛋白，该异常蛋白可能是创伤后免疫抑制的主要原因之一。

Aim:Inordertoanalyzetherelationshipbetweentheprogonosisandabnormalproteininserumofin-juredpatient.Methods:Twenty-sixpatientssuferedfrommechanicalinjurywereinvolvedinthestudy.ThepatientsweredividedintothreegroupsaccordingtotheInjurySeverityScore(ISS),inwhichISSbelow16wasdefinedasamildgroup,ISSbetween16and25asamoderategroup,andISSequalorabove25assevereone.TheefectsoftheserafromthesepatientsontheproductionofIL-2andblastogenesisofperipheralbloodmononuclearcels(PBMC)ofhealthvolunteerstimulatedbyPHAweretested.TheserumabnormalproteinwasalsoanalyzedbySDS-PAGE.Results:AlserumsamplesfrominjuredpatientswereshownsuppressiveactiononproductionofIL-2andblastogenesisofPBMC.Theabnormalproteinwasdetectedintenpatients'serumsamples.Thesevererthepatientinjured,thehigherrateoftheabnormalproteinintheserumofthepatientwasfound.ISSwashigherinpatientswhoseserapresentedthemarkedabnormalproteinthanthosewhoseseradidnotpresenttheprotein(23/14.6).Conclusion:Anabnormalproteinwithmolecularweightofabout9000wasfoundintheserumofmechanicalinjuredpatients.Thesubstancemightbeoneofthemainreasonsforimmunosuppressionafterinjury.Theabnormalproteinmightpredictthepoorprognosisofthein-juredpatient.