Diminished mononuclear cell function is associated with chronic venous insufficiency.
Diminished mononuclear cell function is associated with chronic venous insufficiency.
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单核细胞功能减弱与慢性静脉功能不全有关。
DOI：
10.1016/s0741-5214(95)70042-0
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发表时间：
1995
影响因子：
4.3
通讯作者：
Hobson2nd,RW
中科院分区：
文献类型：
--
作者：
Pappas,PJ;Teehan,EP;Fallek,SR;Garcia,A;Araki,CT;Back,TL;Durán,WN;Hobson2nd,RW
目的随着慢性静脉功能不全（CVI）的临床进展，真皮内单个核细胞浸润增加。由于这些细胞调节慢性炎症反应并调节伤口愈合，细胞功能障碍可以解释CVI伤口愈合的改变。本研究的目的是确定是否与CVI患者的单核细胞是dysfunctional. MethodsMonocytes细胞功能测定的增殖程度在有丝分裂的挑战。将50例患者分为4组：第1组，14例肢体正常;第2组，10例2级CVI患者;第3组，15例活动性静脉溃疡患者;第4组，11例静脉溃疡愈合且目前有脂肪皮肤病证据的患者。双功扫描和空气容积描记术与CVI的临床分型相关。通过肘前静脉穿刺从组1至组4获得全身循环单核细胞和淋巴细胞。根据先前的剂量反应实验，在存在1、8、31和125 μg/孔的葡萄球菌肠毒素A、B、C1、D和E（促分裂原）的情况下培养细胞。5 μg/孔的植物血凝素（PHA）用作对照促分裂原。剂量-反应曲线表明，8 μg/孔引起最大程度的细胞增殖。分析了8 μg/孔下第1组至第4组的抑制反应的统计学显著性。使用非参数Mann Whitney U事后检验和单尾不配对t检验进行组间比较。结果CVI患者外周血淋巴细胞和单核细胞对PHA的反应性并不完全受抑制。然而，第2组患者对PHA的增殖程度与第1、3和4组不同。第2组和第1组（44.38 ± 43.9 vs 118.87 ± 27.1，p ≤ 0.05）以及第2组和第3组（44.38 ± 43.9 vs 105.95 ± 60.99，p≤ 0.05）之间的缓解具有显著性。用葡萄球菌肠毒素A和B攻击显示第2组中增殖反应显著减少（42.73 ± 11.55，p≤ 0.05）和3（45.57 ± 9.1，p≤ 0.05）和组3（36.81 ± 6.9，p ≤ 0.05）和4（35.04 ± 7.5，p≤ 0.05），与葡萄球菌肠毒素A对照相比葡萄球菌肠毒素B对照组（66.25 ± 13.56）。在葡萄球菌肠毒素B、C1、D和E中观察到随着CVI进展单核细胞功能下降的趋势，强烈提示生物学意义。此外，与脂肪皮肤炎患者一致表现出最差的增殖respons. ConclusionsDeverationof单核细胞功能与CVI。观察到增殖反应随临床疾病进展而减少的趋势，表明具有生物学意义。单核细胞增殖响应于各种挑战的能力降低可能在临床上表现为伤口愈合不良和延长。（J VASC SURG 1995;22：580-6.）
PurposeWith clinical progression of chronic venous insufficiency (CVI), dermal infiltration of mononuclear cells increases. Because these cells regulate chronic inflammatory responses and modulate wound healing, cellular dysfunction could explain alterations in wound healing with CVI. The purpose of this study was to determine whether monocytes in patients with CVI are dysfunctional.MethodsMononuclear cell function was measured as the degree of proliferation in response to a mitogenic challenge. Fifty patients were separated into four groups: group 1, 14 patients with normal limbs; group 2, 10 patients with class 2 CVI; group 3, 15 patients with active venous ulcers; group 4, 11 patients with healed venous ulcers and current evidence of lipodermatosclerosis. Duplex scanning and air plethysmography correlated with the clinical classification of CVI. Systemically circulating monocytes and lymphocytes were obtained by antecubital venipuncture from groups 1 to 4. Cells were cultured in the presence of staphylococcal enterotoxins A, B, C1, D, and E (mitogens) at 1, 8, 31, and 125 μg/well on the basis of previous dose-response experiments. Phytohemagglutinin (PHA), 5 μg/well, served as a control mitogen. The dose-response curves indicated that 8 μg/well elicited the greatest degree of cell proliferation. Proliferative responses at 8 μg/well were analyzed for statistical significance among groups 1 to 4. Comparisons among groups were performed by use of the nonparametric Mann Whitney U post tests and a one-tailed unpaired t test. Results were considered significant at p≤ 0.05.ResultsProliferative responses to PHA indicate that lymphocytes and monocytes from patients with CVI are not globally depressed. However, patients in group 2 did not exhibit the same degree of proliferation to PHA as did groups 1, 3, and 4. Proliferative responses between groups 2 and 1 (44.38 ± 43.9 vs 118.87 ± 27.1, p ≤ 0.05) and groups 2 and 3 (44.38 ± 43.9 vs 105.95 ± 60.99, p≤ 0.05) were significant. Challenges with staphylococcal enterotoxin A and B reveal significant diminution of proliferative responses in groups 2 (42.73 ± 11.55, p≤ 0.05) and 3 (45.57 ± 9.1, p≤ 0.05) and groups 3 (36.81 ± 6.9, p ≤ 0.05) and 4 (35.04 ± 7.5, p≤ 0.05), compared with staphylococcal enterotoxin A controls (68.68 ± 9.9) and staphylococcal enterotoxin B controls (66.25 ± 13.56), respectively. A trend of diminished mononuclear cell function with progression of CVI was observed with staphylococcal enterotoxins B, C1, D, and E, strongly suggesting biologic significance. Furthermore, patients with lipodermatosclerosis uniformly exhibited the poorest proliferative responses.ConclusionsDeterioration of mononuclear cell function is associated with CVI. A trend of diminishing proliferative responses with clinical disease progression is observed and suggests biologic significance. The decreased capacity for mononuclear cell proliferation in response to various challenges may manifest itself clinically as poor and prolonged wound healing. (J VASC SURG 1995;22:580-6.)
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