DECREASED IMMUNE REACTIVITY AND NEUROENDOCRINE ALTERATIONS RELATED TO CHRONIC STRESS IN SPINAL-CORD INJURY AND STROKE PATIENTS
DECREASED IMMUNE REACTIVITY AND NEUROENDOCRINE ALTERATIONS RELATED TO CHRONIC STRESS IN SPINAL-CORD INJURY AND STROKE PATIENTS
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DOI：
10.1159/000163790
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发表时间：
1993-05-01
期刊：
影响因子：
5
通讯作者：
BRITT, R
中科院分区：
文献类型：
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作者：
CRUSE, JM;LEWIS, RE;BRITT, R
54例脊髓损伤和卒中患者(其中四肢瘫痪28例，截瘫21例，卒中5例)伤后2周自然免疫反应和获得性免疫反应均显著低于年龄匹配的对照组。所有的值都表示为均值。脊髓损伤后2周自然杀伤(NK)细胞功能下降至21.0%，而对照组为48.6%。治疗2周时，患者血浆ACTH值由对照组的11.2pg/ml升至17.0pg/ml，尿游离皮质醇水平由对照组的53.6ug/24 h升至162.4µg/24 h。伤后3个月T细胞功能下降至正常(淋巴细胞转化)的40.2%。T细胞活化(IL-2R)降低，为183.4微克/毫升，而对照组为328.2微克/毫升。经过康复治疗，伤后7个月NK细胞功能提高到41.6%。NK细胞介导的裂解在7到9个月间急剧下降，在10个月时下降到22.8%，最终恢复到损伤后2周的水平。康复治疗使T细胞功能在伤后6个月恢复到正常的92.0%，并保持在6个月以上。IL、2R值与淋巴细胞转化率同步提高。未接受治疗的患者NK细胞诱导的溶血仍处于抑制状态，6个月时为11.8%，12个月以上时为11.4%，而康复患者的NK细胞功能在6个月后恢复到40.6%，在停止治疗后下降到23.0%。颈椎损伤患者NK细胞介导的溶血值明显低于胸部损伤患者。两组患者的功能独立性测量(FIM)评分与其NK细胞功能相平行。康复治疗后，颈椎组NK细胞介导的溶血率从15.2%提高到28.4%，而胸腔组从26.8%提高到43.7%。康复治疗后，颈段组淋巴细胞转化率由37.3%提高到85.6%，胸段组由48.4%提高到88.9%。经过康复治疗，颈椎组的FIM评分从49.7分提高到74.0分，胸科患者的FIM评分从79.8分提高到97.3分，而对照组为126分。5例卒中患者NK细胞介导的溶血率降至28.9%，康复治疗后改善至38.0%。
Both natural and adaptive immune responses were found to be strikingly decreased 2 weeks after injury in 54 spinal cord injury and stroke patients, i.e., 28 quadriplegics, 21 paraplegics and 5 stroke patients, compared with those of age-matched controls. All values are expressed as means. Natural-killer (NK)-cell function decreased to 21.0% 2 weeks after spinal cord injury compared with 48.6% in controls. At 2 weeks, plasma ACTH values increased to 17.0 pg/ml in patients compared with 11.2 pg/ml in controls, and urine free cortisol levels were elevated to 162.4 mug/24 h in patients compared with 53.6 mug/24 h in controls. T-cell function decreased to 40.2% of normal (lymphocyte transformation) by 3 months after injury. T-cell activation (IL-2R) was diminished, i.e., 183.4 mug/ml compared with 328.2 mug/ml in controls. With rehabilitation therapy, NK-cell function increased to 41.6% by 7 months after injury. NK-cell-mediated lysis diminished sharply between 7 and 9 months, decreasing to 22.8% at 10 months and ultimately returning to the level seen 2 weeks after injury. Rehabilitation therapy contributed to the restoration of T-cell function to 92.0% of normal by 6 months after injury where it remained for 6+ months. IL,2R values improved in parallel with lymphocyte transformation. Whereas NK-cell-induced lysis remained depressed, i.e., 11.8% at 6 months and 11.4% at 12+ months in patients not receiving therapy, the restoration of NK-cell function at 6 months to 40.6% in rehabilitated patients decreased to 23.0% with cessation of treatment. NK-cell-mediated lysis values in cervical injury patients were significantly less than those in the thoracic injury group. Functional independence measurement (FIM) scores of the two paralleled their NK-cell function. With rehabilitation therapy, NK-cell-mediated lysis in the cervical group increased from 15.2 to 28.4%, whereas it improved in the thoracic group with therapy from 26.8 to 43.7%. With rehabilitation therapy, lymphocyte transformation in the cervical group increased from 37.3 to 85.6% and improved in the thoracic group from 48.4 to 88.9%. With rehabilitation therapy, FIM scores improved from 49.7 to 74.0 in the cervical group and from 79.8 to 97.3 in thoracic patients compared with 126 in controls. NK-cell-mediated lysis was depressed to 28.9% in 5 stroke patients and improved to 38.0% following rehabilitation therapy.