严重多发伤后免疫紊乱与急性胃肠功能损伤间的关系

目的:探讨严重多发伤患者伤后免疫紊乱与急性胃肠功能损伤（acute gastrointestinal injury, AGI）间的关系。方法:纳入同济医院创伤外科2018年4月至2019年10月收治的严重多发伤患者205例，选取23例健康志愿者作为对照组。依据AGI诊断标准将患者分为AGI组与不伴AGI组（N-AGI组）；AGI组根据严重程度又分为轻度AGI组（L-AGI组）与重度AGI组（S-AGI组）。收集患者临床资料，于伤后1、7、14 d采集患者外周血，检测淋巴细胞亚群比率及炎症因子水平。采用 t检验或 χ2检验比较各指标的组间差异，logistic回归分析AGI发生的免疫相关危险因素。 结果:79.5%的严重多发伤患者伴发AGI（163/205例）。与N-AGI组患者相比，AGI组在伤后1 d总T淋巴细胞（Tc）、辅助性T淋巴细胞（Th）比率；7 d的白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）及白细胞介素-10（IL-10）水平，抑制性T淋巴细胞（Ts）、Th/Ts与调节性T淋巴细胞（Treg）比率；14 d的IL-8与IL-10水平，Ts、Th/Ts及Treg比率方面均差异有统计学意义（ P<0.05）。与L-AGI组患者相比，S-AGI组在伤后1 d的Tc、Th比率，IL-6与TNF-α水平；7 d和14 d的Ts、Th/Ts与Treg比率，IL-8与IL-10水平方面均差异有统计学意义（ P<0.05）。Logistic回归分析显示：Ts 7 d（ OR=2.018，95% CI：1.105~5.364， P=0.013）、Treg 14 d（ OR=3.612，95% CI：1.375~8.476， P=0.006）、IL-6 7 d（ OR=1.824，95% CI：1.011 ~5.835， P=0.024）、IL-10 14 d（ OR=2.847，95% CI：1.241~6.216， P=0.014）、TNF-α 7 d（ OR=1.754，95% CI：1.215~5.441， P=0.018）是严重多发伤后伴发AGI的高危因素。 结论:严重多发伤后机体免疫紊乱易诱发AGI，且伴发AGI将导致伤后免疫紊乱的持续加重。

The relationship between immune disorder and acute gastrointestinal injury in patients after severe polytrauma

Objective:To retrospectively assess the relationship between immune disorder and acute gastrointestinal injury (AGI) in patients after severe polytrauma.Methods:Totally 205 patients with severe polytrauma admitted to Tongji Hospital from April 2018 to October 2019 were enrolled as the observation group, and 23 healthy volunteers were served as the control group. According to the diagnostic criteria of AGI, all patients were divided into the AGI group (with AGI) or N-AGI group (without AGI), AGI patients were divided into the S-AGI group or L-AGI group according to the severity. The levels of cytokines and lymphocyte subset were evaluated at day 1, 7, and 14 after severe polytrauma. The differences between groups were statistically analyzed. The independent risk factors of AGI were analyzed by Logistic regression analyzed.Results:Totally 79.5% (163/205) of patients with severe polytrauma were accompanied by AGI. There were significant differences in the ratio of Tc, Th at day 1 after trauma, the levels of IL-6, TNF-α, IL-8, IL-10, the ratio of Ts, Th/Ts, Treg at day 7 after trauma, and the levels of IL-8, IL-10,the ratio of Ts, Th/Ts, Treg at day 14 after trauma between the AGI group and N-AGI group ( P<0.05). There were significant differences in the ratio of Tc, Th, the levels of IL-6, TNF-α at day 1 after trauma and the ratio of Ts, Th/Ts, Treg, the levels of IL-8, IL-10 at day 7 and 14 after trauma between the S-AGI group and L-AGI group ( P<0.05). Logistic regression analysis showed that Ts 7 d ( OR=2.018, 95% CI: 1.105-5.364, P=0.013), Treg 14 d ( OR=3.612, 95% CI: 1.375-8.476, P=0.006), IL-6 7 d ( OR=1.824, 95% CI: 1.011-5.835, P=0.024), IL-10 14 d ( OR=2.847, 95% CI: 1.241-6.216, P=0.014), TNF-α 7 d ( OR=1.754, 95% CI: 1.215-5.441, P=0.018) were independent risk factors in patients with AGI after severe polytrauma. Conclusions:AGI is more easily occurred in patients with the heavier immune disorders after severe polytrauma. AGI can also aggravate pre-existing immune disorders in patients after severe polytrauma.