Older Patients Are Immunocompromised by Cytokine Depletion and Loss of Innate Immune Function After HIP Fracture Surgery.
Older Patients Are Immunocompromised by Cytokine Depletion and Loss of Innate Immune Function After HIP Fracture Surgery.
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DOI：
10.1177/2151458515605564
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发表时间：
2015-12
影响因子：
1.6
通讯作者：
Liversidge J
中科院分区：
文献类型：
--
作者：
Sutherland AG;Cook A;Miller C;Duncan L;Yuecel R;Heys SD;Hutchison JD;Liversidge J
我们检查了因髋部骨折接受手术的老年患者的免疫状态，以确定特定的免疫缺陷，髋部骨折是一种与术后预后不良相关的损伤。在一项队列观察性研究中，16例接受髋关节骨折手术的患者在术前进行了免疫功能评估，然后在术后3天和7天，使用流式细胞术进行表型以及单核细胞和粒细胞吞噬功能和呼吸爆发。储存血清样品，并使用人细胞因子25-plex面板进行批量分析。我们报告了先天免疫功能的显著丧失，特别是与第7天减少的粒细胞数量相关（P <0.0001，流式细胞术; P <0.05白色血细胞），尽管粒细胞摄取调理大肠杆菌的能力增加（P <0.05），但这些细胞产生呼吸爆发的能力在第3天和第7天降低（P <0.05）。单核细胞呼吸爆发也显著减少（P <0.05）。血清细胞因子水平表明T细胞功能非常差。我们已经证明，老年髋部骨折患者手术后抗菌免疫反应大大降低。该效果持续至术后7天，确定这些患者特别容易受到细菌感染。
We have examined the immune status of elderly patients who underwent surgery for a hip fracture, an injury associated with poor postoperative outcomes, to identify specific immune defects. In a cohort observational study, 16 patients undergoing surgery for hip fractures had immune function evaluation prior to surgery, and then at 3 and 7 days postoperatively, using flow cytometry for phenotype and for monocyte and granulocyte phagocytic function and respiratory burst. Serum samples were stored and batch analyzed using a human cytokine 25-plex panel. We report significant loss of innate immune function, related specifically to reduced granulocyte numbers by day 7 (P < .0001, flow cytometry; P < .05 white blood cells), and although granulocyte ability to take up opsonized Escherichia coli was increased (P < .05), the ability of those cells to generate a respiratory burst was reduced at days 3 and 7 (P < .05). Monocyte respiratory burst was also significantly reduced (P < .05). Serum cytokine levels indicated very poor T-cell function. We have demonstrated that the antimicrobial immune response is profoundly reduced after surgery in elderly patients with hip fractures. The effect was sustained up to 7 days postoperatively, identifying these patients as particularly vulnerable to bacterial infections.