开放性骨折早期外周血T细胞亚群,IL2活性及Tac抗原表达的变化

Alterations of T lymphocyte subsets, IL-2 activity and expression of IL--2R (Tac antigen) in patients with open fractures

目的：研究不同程度开放性骨折早期机体免疫功能变化．方法：按照朱通伯的开放性骨折分类标准，将２１例患者分为两组：轻伤组，为Ⅰ，Ⅱ度开放性骨折（共１０例）；重伤组，为Ⅲ度开放性骨折（共１１例）．用ＡＰＡＡＰ法和生物学测定法分别检测在伤后当日，５ｄ，１０ｄ，１５ｄ患者外周血单个核细胞的Ｔ淋巴细胞亚群变化和经植物血凝素（ＰＨＡ，１０ｍｇ／Ｌ）刺激后ＩＬ－２活性及ＩＬ－２Ｒ（Ｔａｃ抗原）表达变化．结果：伤后当日，５ｄ两组Ｌｅｕ４（总Ｔ细胞）、Ｌｅｕ３ａ（辅助性Ｔ细胞）及Ｔａｃ阳性细胞百分比明显下降（Ｐ＜０．０５，Ｐ＜０．０１），Ｌｅｕ２ａ（抑制性Ｔ细胞／杀伤性Ｔ细胞）细胞百分比无显著变化（Ｐ＞０．０５）；ＩＬ－２产生明显减少（Ｐ＜０．０１）．轻伤组下降各值在伤后５ｄ开始回升，伤后１０ｄ，１５ｄ接近正常；重伤组各值下降比轻伤组更为明显，而且回升缓慢．结论：开放性骨折早期Ｔｈ淋巴细胞功能受损，ＩＬ－２活性和ＩＬ－２Ｒ表达受抑，免疫功能下降程度与创伤严重程度相关．

AIM: To study injury induced immunosuppressionin open fractures of different grades. METHODS: Accordingto Zhu Tongbo's classification of open fractures, 21 patientswere divided into two groups: group A--Type fractures(10 cases); group B Type fractures (11 cases). Peripheral blood mononuclear cells (PBMC ) from the peripheralblood samples of the patients obtained at 0 d, 5 d, 10 d, 15 dpost--injury were collected. Percentages of total T lymphocytes, helper T cells, suppressor/cytotoxic T cells and Taopositive cells (from the PBMC cultures activated by PHA, 10mg/L) identified by monoclonal antibodies (McAb) of Leu4,Leu3a, Leu2a and anti-Tao respectively were assessed by using APAAP method. Production of IL--2 in the cultures asmentioned above by determining the extent of proliferation ofan IL--2 dependent cell line (CTLL2) was assessed by usingMTT method. RESULTS: During the 15 days after injury,percentages of Leu4, Leu3a cells and Tac positive cells andproduction of IL--2 by PBMC in both groups reduced significantly as compared with the normal values or the controls (P<0. 05,P<0. 01 ) and the parameters above in group A experienced a transient decline in 5 days which was followed by arapid restoration whereas those in group B had a profound decrease and remained at a low level. CONCLUSION: In theearly stage of open factures helper T cells are impaired andproduction of IL--2 and expression of IL--2R are reduced. Theimmunosuppression following open fractures parallells theseventy of the trauma.