IMMUNOLOGICAL ASPECTS OF HEMORRHAGE

我们的研究表明，出血会导致明显的抑郁症。 在细胞介导的免疫中，尽管液体复苏和 增加败血症的易感性。初步研究表明：a) 脾细胞中的三磷酸腺苷水平(用31P-核磁共振)几乎检测不到 出血，复苏后2小时仍保持抑郁；b) 出血使脾巨噬细胞(Mphi)细胞内钙离子升高 降低对刺激物的反应；c)暴露在低氧环境下 环境(无出血)、Mphi抗原提呈(AP)功能 受到抑制，PGE2产量增加。因此，我们的假设， 出血会导致局部缺氧，从而导致细胞ATP 减少，导致钙稳态/第二信使的改变 系统，细菌移位(即内毒素释放)，以及 刺激库普弗细胞产生炎性细胞因子。这张网 上述事件的结果(S)是前列腺素E_2产生增加，这是中介 Mphi(AP及相关突起)和脾细胞的抑制 功能(增殖和淋巴因子生成)，产生 免疫抑制和败血症的易感性增加。研究是 建议确定是否：1)出血和复苏 以及没有免疫调节(使用诸如ATP-MgCl2、钙 拮抗剂、抗内毒素、IL-6或肿瘤坏死因子抗体、氯喹)、AS 与低氧相比，脾细胞和Mphi-ATP/钙均发生改变 水平和前列腺素E_2的产生；2)出血或缺氧会引起改变 在第二信使系统中；3)Mphi细胞因子的变化 失血复苏后使用和不使用上述两种方法的生产 免疫调节剂本质上是转录和/或翻译的。是这样的 研究将确定肿瘤坏死因子和白介素6的基因表达 在出血/免疫调节后发生改变。此外，现场 将进行杂交以定位细胞隔间 细胞因子产生的改变；以及4)花生四烯酸储备的耗尽 出血前使用omega-3脂肪酸饮食可以预防抑郁症 出血后巨噬细胞和脾细胞功能的变化。对.的使用 生化、生理、细胞和分子生物学技术 确定免疫抑制和免疫增强的机制 出血和复苏后的脓毒症易感性应 为患者的治疗和护理提供有用的信息 大量失血。

Our studies have demonstrated that hemorrhage produces a marked depression in cell-mediated immunity which persists despite fluid resuscitation and increases susceptibility to sepsis. Preliminary studies indicate that: a) ATP levels (by 31P-NMR) in splenocytes are barely detectable after hemorrhage and remain depressed even 2 hrs after resuscitation; b) hemorrhage increases splenic macrophage (Mphi) intracellular Ca2+ while decreasing the response to stimulant; c) after exposure to hypoxic environment (without hemorrhage), Mphi antigen presentation (AP) function is depressed and PGE2 production is increased. Our hypothesis, therefore, is that hemorrhage produces regional hypoxia which causes cell ATP to decrease, inducing alterations in calcium homeostasis/second messenger systems, translocation of bacteria (i.e. endotoxin release), and stimulation of Kupffer cells to produce inflammatory cytokines. The net results of the above event(s) is increased PGE2 production, which mediates the depression of Mphi (AP and associated processes) and splenocyte function (proliferation and lymphokine generation), producing immunodepression and increasing susceptibility to sepsis. Studies are proposed to determine whether or not: 1) hemorrhage and resuscitation with and without immunomodulation (with agents such as ATP-MgCl2, calcium antagonists, anti-endotoxin, IL-6 or TNF antibodies, chloroquine), as compared to hypoxia, produce alterations in splenocyte and Mphi ATP/calcium levels and PGE2 production; 2) hemorrhage or hypoxia produces alterations in the second messenger system; 3) the alterations in Mphi cytokine production after hemorrhage and resuscitation with and without the above immunomodulators are transcriptional and/or translational in nature. Such studies will determine whether or not the gene expression for TNF and IL-6 is altered after hemorrhage/immunomodulation. Additionally, in situ hybridization will be carried out to localize the cellular compartments of altered cytokine production; and 4) depletion of arachidonic acid stores before hemorrhage using omega-3 fatty acid diet will prevent the depression of Mphi and splenocyte functions following hemorrhage. The use of biochemical, physiological, cellular and molecular biological techniques to determine the mechanism responsible for immunodepression and increased susceptibility to sepsis following hemorrhage and resuscitation should provide useful information for the treatment and care of patients with major blood loss.