Trauma: the role of the innate immune system.
Trauma: the role of the innate immune system.
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DOI：
10.1186/1749-7922-1-15
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发表时间：
2006-05-20
期刊：
影响因子：
--
通讯作者：
Leenen, Lph
中科院分区：
文献类型：
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作者：
Hietbrink, F;Koenderman, L;Leenen, Lph
免疫功能障碍可导致严重受伤患者的(多)器官衰竭。这种功能障碍表现为两种形式，遵循双相模式。在第一阶段，除了创伤造成的损伤外，全身炎症反应期间的免疫系统也会造成器官损伤。在第二阶段，由于宿主防御失败(免疫麻痹)，患者更容易发生败血症。这篇综述中概述的病理生理学模型包括病因和先天免疫系统在最终器官损害中的作用。病因可分为内在因素(遗传倾向和生理状态)和外在因素(损伤类型或“创伤负荷”和手术或“干预负荷”)。在所有因素中，干预负荷是唯一可以由主治医师改变的因素。调整治疗方法，选择最合适的治疗策略，可以最大限度地减少免疫反应造成的损害，防止免疫性瘫痪的发展。这篇综述为损伤控制的概念提供了病理生理学基础，其中分期手术和创伤后免疫监测已成为治疗方案的重要方面。先天免疫系统是免疫监测的主要目标，因为它在创伤后器官衰竭中起着最突出的作用。在导致器官衰竭的过程中，多形核巨噬细胞和单核细胞是先天免疫系统的主要效应细胞。这些细胞受细胞因子、趋化因子、补体因子和特定组织信号的控制。进一步评估了组织屏障完整性的贡献及其与先天免疫系统的相互作用。
Immune dysfunction can provoke (multiple) organ failure in severely injured patients. This dysfunction manifests in two forms, which follow a biphasic pattern. During the first phase, in addition to the injury by trauma, organ damage is caused by the immune system during a systemic inflammatory response. During the second phase the patient is more susceptible for sepsis due to host defence failure (immune paralysis). The pathophysiological model outlined in this review encompasses etiological factors and the contribution of the innate immune system in the end organ damage. The etiological factors can be divided into intrinsic (genetic predisposition and physiological status) and extrinsic components (type of injury or "traumaload" and surgery or "intervention load"). Of all the factors, the intervention load is the only one which, can be altered by the attending emergency physician. Adjustment of the therapeutic approach and choice of the most appropriate treatment strategy can minimize the damage caused by the immune response and prevent the development of immunological paralysis. This review provides a pathophysiological basis for the damage control concept, in which a staged approach of surgery and post-traumatic immunomonitoring have become important aspects of the treatment protocol. The innate immune system is the main objective of immunomonitoring as it has the most prominent role in organ failure after trauma. Polymorphonuclear phagocytes and monocytes are the main effector-cells of the innate immune system in the processes that lead to organ failure. These cells are controlled by cytokines, chemokines, complement factors and specific tissue signals. The contribution of tissue barrier integrity and its interaction with the innate immune system is further evaluated.