PREDICTING FATAL SEPSIS IN BURN PATIENTS
PREDICTING FATAL SEPSIS IN BURN PATIENTS
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DOI：
10.1097/00005373-197909000-00001
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发表时间：
1979-01-01
影响因子：
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通讯作者：
TRUNKEY, DD
中科院分区：
文献类型：
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作者：
BAKER, CC;MILLER, CL;TRUNKEY, DD
严重热损伤后的高发病率被认为部分与由此导致的免疫能力下降有关。我们测试了植物血凝素（PHA）和刀豆蛋白（Con A）对17例中重度热损伤（> 25% BSA）患者淋巴细胞转化的刺激能力。这些患者作为他们自己的对照，随着时间的推移，他们的有丝分裂原反应变化的百分比被测量出来。8例急性烧伤患者随后发展为严重脓毒症（第一组），其对PHA的反应能力下降（平均为正常人的12%），其中6例死于严重脓毒症。抑郁反应出现在损伤后4 - 7天，比败血症的临床证据早2 - 4天。有轻度感染并发症的4例患者（II组）的细胞在损伤后约7至10天表现出显著增强的丝裂原反应（平均+ 243%）。5例临床过程无脓毒症的烧伤患者（III组）的有丝分裂原反应只有最小的变化（平均+ 30%）。尽管患者细胞的Con A反应与其病理的对应程度较低，但第一组患者的细胞表现出PHA反应性低下，Con A反应也减弱。II组患者的细胞也表现出Con a诱导的刺激增加。HI组患者只有轻微增强的PHA反应，Con a诱导的淋巴细胞转化有最小的减少。许多严重烧伤的病人由于创面大而出现败血症。然而，丝裂原诱导的增殖减少的出现似乎是那些无法处理脓毒性挑战的患者的特征。
The high morbidity after severe thermal insult is believed to be related partially to a resultant decrease in immunocompetence. We tested the ability of phytohemagglutinin (PHA) and Concanavalin (Con A) to stimulate lymphocyte transformation in 17 patients with moderate to severe thermal injury (> 25% BSA). The patients acted as their own controls and the per cent change in their mitogen response was measured over time. Eight acutely burned patients who subsequently developed severe sepsis (Group I) had decreased ability (mean, 12% of normal) to proliferate in response to PHA, and six of these died of severe sepsis. The depressed response appeared 4 to 7 days postinjury and predated clinical evidence of sepsis by 2 to 4 days. Cells from four patients who had mild infectious complications (Group II) demonstrated greatly augmented mitogen responses (mean+ 243%) approximately 7 to 10 days postinjury. Five burn patients whose clinical course was sepsis free (Group III) exhibited only minimal changes in their mitogen responses (mean+ 30%). Although the Con A responses of the patients' cells corresponded less to their pathology, Group I patients whose cells exhibited depressed PHA responsiveness also had diminished Con A responses. Group II patients' cells also showed increases in Con A-induced stimulation. Group HI patients, who had only slightly augmented PHA responses, had minimal decreases of the Con A-induced lymphocyte transformation. Many severely burned patients develop septicemia as a result of their large wound surfaces. The appearance of decreases in mitogen-induced proliferation, however, appears to characterize those patients who will be unable to handle the septic challenge.