严重创伤后多器官功能不全与 NK 变化关系的研究

Relationship between the multiple organ dysfunction syndrome and variation of NK cells in patients with major trauma

目的：探讨严重创伤后患者血液中NK细胞的动态变化与发生并发症的关系。方法42例严重创伤患者于入院当时及伤后1、3、7 d抽血检测外周血中NK细胞，并监测心、肺、肝、肾等脏器功能；分析NK细胞在多脏器功能衰竭（ MODS）组、炎症反应综合征组（ SIRS）、无并发症组（ Un）各组中的变化规律。结果①创伤后当天NK细胞在MODS组与SIRS组均高于健康对照组；MODS组在创伤后1、3、7 d NK细胞高于健康对照组；SIRS组在创伤后1、3 d NK细胞仍高于健康对照组；Un组NK细胞在伤后0 d略有升高，在1 d即恢复至正常水平。②MODS组在创伤后NK细胞始终高于Un组；SIRS组NK细胞仅在伤后当天高于Un组。结论严重创伤后不同并发症患者外周血中NK细胞的变化并不相同，动态监测免疫功能的变化情况可对创伤后并发症的发生有一定的预警作用，应根据免疫细胞的变化情况制订治疗方案。

Objective To investigate the relationship between the dynamic variation of NK cells and the severe complications in patients with major trauma .Methods According to ISS scores , 42 patients with major trauma were enrolled .At admission and 1, 3, 7 days after injury, peripheral blood were sampled to detect NK cells, and the pulmonary, hepatic, renal and cardiac function were evaluated.Furthermore, the variation of NK cells in the multiple organ dysfunction syndrome （ MODS） group, the inflammatory response syndrome （ SIRS） group and the uncomplicated （ Un） group were analyzed statistically .Results ①Compared with the normal control group , NK cells in the MODS and SIRS groups significantly increased at admission .Compared with the normal control group , NK cells in MODS group significantly increased 1, 3 and 7 days after trauma.Compared with the normal control group, NK cells in the SIRS group significantly increased 1 and 3 days after trauma .NK cells in the Un group recovered to normal level 1 day after trauma .②Compared with the Un group , NK cells significantly increased in the MODS group after trauma .However , NK cells in the SIRS group were higher than that of the Un group only at admission .Conclusion The variation of NK cells are different in different complications after major trauma .Therefore, dynamical monitoring the variation of immune cells maybe play a predictive role for complications after major trauma .Furthermore, the strategy of immune modulating therapies for major trauma should be based on changes of immune cells .