Systemic inflammation after trauma
Systemic inflammation after trauma
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DOI：
10.1016/j.injury.2007.10.003
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发表时间：
2007-12-01
影响因子：
2.5
通讯作者：
Cheadle, William G.
中科院分区：
文献类型：
--
作者：
Lenz, Andreas;Franklin, Glen A.;Cheadle, William G.
创伤仍然是全世界人口死亡的主要原因之一。受伤后早期发生的死亡是由于“第一次打击”，包括严重器官损伤、缺氧、低血容量或头部外伤。大规模损伤导致免疫系统激活，创伤后早期炎症免疫反应被定义为全身炎症反应综合征（SIRS）。感染、缺血/再灌注或手术等“二次打击”可进一步增强促炎性免疫反应，并与创伤后后期的高发病率和死亡率相关。 SIRS 可导致最初未受初始创伤影响的器官发生组织破坏，并随后发展为多器官功能障碍 (MOD)。最初的促炎反应随后是抗炎反应，可能导致免疫抑制，从而导致感染和败血症的高风险。创伤会导致免疫系统几乎所有组成部分的激活。它激活神经内分泌系统和局部组织破坏以及代谢呼吸有毒副产物的积累导致介质的释放。广泛的组织损伤可能导致这些介质溢出到外周血流中，以进一步维持和增强促炎反应。激素如促肾上腺皮质激素、皮质类固醇和儿茶酚胺以及细胞因子、趋化因子和警报素在严重损伤后促炎反应的启动和持续中发挥着重要作用。因此，本综述的目的是描述创伤后的免疫事件，并介绍炎症免疫反应的重要介质和途径。 (C) 2007 Elsevier Ltd. 保留所有权利。
Trauma is still one of the main reasons for death among the population worldwide. Mortality occurring early after injury is due to "first hits", including severe organ injury, hypoxia, hypovolaemia or head trauma. Massive injury leads to activation of the immune system and the early inflammatory immune response after trauma has been defined as systemic inflammatory response syndrome (SIRS). "Second hits" such as infections, ischaemia/reperfusion or operations can further augment the pro-inflammatory immune response and have been correlated with the high morbidity and mortality in the latter times after trauma. SIRS can lead to tissue destruction in organs not originally affected by the initial trauma with subsequent development of multi-organ dysfunction (MOD). The initial pro-inflammatory response is followed by an anti-inflammatory response and can result in immune suppression with high risk of infection and sepsis. Trauma causes activation of nearly all, components of the immune system. It activates the neuroendocrine system and local tissue destruction and accumulation of toxic byproducts of metabolic respiration leads to release of mediators. Extensive tissue injury may result in spillover of these mediators into the peripheral bloodstream to further maintain and augment the pro-inflammatory response. Hormones Like ACTH, corticosteroids and catecholamines as well as cytokines, chemokines and alarmins play important roles in the initiation and persistence of the pro-inflammatory response after severe injury. The purpose of this review is therefore to, describe the immunological events after trauma and to introduce important mediators and pathways of the inflammatory immune response. (C) 2007 Elsevier Ltd. All rights reserved.