Immunosuppression following surgical and traumatic injury.
Immunosuppression following surgical and traumatic injury.
复制标题
DOI：
10.1007/s00595-010-4323-z
复制
发表时间：
2010-09
期刊：
影响因子：
2.5
通讯作者：
Miyazaki M
中科院分区：
文献类型：
--
作者：
Kimura F;Shimizu H;Yoshidome H;Ohtsuka M;Miyazaki M
严重脓毒症和器官功能衰竭仍是肝胆胰大手术后并发症和死亡的主要原因。尽管最近在了解腹腔脓毒症的免疫状况方面取得了进展，但主要内脏手术后脓毒症并发症的发生率仍然很高。本文综述了决定大手术和创伤后感染性并发症发生和致死性结局的临床和免疫学参数。文献综述表明，手术和创伤性损伤深刻地影响先天性和适应性免疫反应，并且过度炎症反应后细胞介导的免疫的显著抑制似乎是对随后败血症的易感性增加的原因。先天性和适应性免疫应答由病原体相关的分子模式分子和损伤相关的分子模式分子通过模式识别受体启动和调节。细胞介导的免疫的抑制可能是由宿主循环和其他区室中多方面的细胞因子/抑制剂谱、多形核中性粒细胞的过度活化和失调募集、具有抗炎特性的交替活化或调节性巨噬细胞的诱导、T辅助细胞（Th）1/Th 2平衡向Th 2的转变、调节性T细胞的出现、其是先天性和适应性免疫系统以及脓毒症患者中淋巴细胞凋亡的有效抑制剂。最近的基础和临床研究已经阐明了手术和创伤性损伤对免疫系统的功能影响。感兴趣的研究在未来可能有助于选择适当的治疗方案。
Severe sepsis and organ failure are still the major causes of postoperative morbidity and mortality after major hepatobiliary pancreatic surgery. Despite recent progress in understanding the immune conditions of abdominal sepsis, the postoperative incidence of septic complications after major visceral surgery remains high. This review focuses on the clinical and immunological parameters that determine the risk of the development and lethal outcome of postoperative septic complication following major surgery and trauma. A review of the literature indicates that surgical and traumatic injury profoundly affects the innate and adaptive immune responses, and that a marked suppression in cell-mediated immunity following an excessive inflammatory response appears to be responsible for the increased susceptibility to subsequent sepsis. The innate and adaptive immune responses are initiated and modulated by pathogen-associated molecular-pattern molecules and by damage-associated molecular-pattern molecules through the pattern-recognition receptors. Suppression of cell-mediated immunity may be caused by multifaceted cytokine/inhibitor profiles in the circulation and other compartments of the host, excessive activation and dysregulated recruitment of polymorphonuclear neutrophils, induction of alternatively activated or regulatory macrophages that have anti-inflammatory properties, a shift in the T-helper (Th)1/Th2 balance toward Th2, appearance of regulatory T cells, which are potent suppressors of the innate and adaptive immune system, and lymphocyte apoptosis in patients with sepsis. Recent basic and clinical studies have elucidated the functional effects of surgical and traumatic injury on the immune system. The research studies of interest may in future aid in the selection of appropriate therapeutic protocols.
登录
查看更多内容
影响因子：
168.9
作者：
Annane, D;Sanquer, S;Bellissant, E
通讯作者：
Bellissant, E
DOI：
10.1097/00005373-200109000-00005
发表时间：
2001-09-01
影响因子：
--
作者：
Adams, JM;Hauser, CJ;Deitch, EA
通讯作者：
Deitch, EA
影响因子：
3.8
作者：
Decker, D;Schondorf, M;vonRuecker, AA
通讯作者：
vonRuecker, AA
影响因子：
20.3
作者：
Arraes, Sandra Mara A.;Freitas, Marta S.;Cunha, Fernando Q.
通讯作者：
Cunha, Fernando Q.
影响因子：
3.9
作者：
Cauwels, Anje;Brouckaert, Peter
通讯作者：
Brouckaert, Peter