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Verlauf und prognostische Bedeutung immunologischer Funktionsparameter nach schwerem Traum

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Zusammenfassung

Ein schweres generalisiertes Trauma führt zu einer erhöhten Inzidenz von SIRS, Sepsis und MOV. Ziel dieser prospektiven Patientenstudie ist es an einem Patientenkollektiv mit ähnlicher Verletzungsschwere die Entzündungs- und Immunparameter bezüglich ihrer Korrelation und ihrer Prädiktion für ein Multiorganversagen zu untersuchen.

Von insgesamt 16 polytraumatisierten Patienten mit einem ISS>25 wurde die HLA-DR-Expression auf peripheren Monozyten mittels Durchflusszytometrie, die Ex-vivo-TNF-α-Synthese nach Endotoxin-Stimulation im Vollblut, sowie die Serumspiegel von IL-6, IL-10, Procalcitonin (PCT) und CRP im Serum mittels ELISA bestimmt.

Initial nach Trauma kommt es zu einer Erhöhung von IL-6, PCT und IL-10 im Serum sowie einer Reduktion der TNF-α-Synthesefähigkeit und der Expression von HLA-DR auf Monozyten. Bei Patienten mit MOV zeigten am Tag 3–4 nach Trauma erhöhte IL-10-Serumspiegel und eine ausbleibende Erholung der HLA-DR-Expression ebenfalls am Tag 3–4 nach Unfall. Dagegen war die TNF-α-Synthesefähigkeit bei Patienten mit MOV in der 2. Woche nach Trauma sogar erhöht. Im weiteren Verlauf zeigten Patienten mit MOV auch höhere PCT-Werte im Serum.

Durch ein Immunmonitoring im Krankheitsverlauf nach Polytrauma lassen sich auch bei extrem schwerstverletzten Patienten immunologische Mediatorkonstellation zeigen, die mit der Entstehung und dem Verlauf eines MOV einhergehen.

Abstract

Generalized severe trauma leads to an increased incidence of SIRS, sepsis, and MOF. The aim of this prospective study was to investigate the immunological parameters in terms of their predictive value for multiple organ failure (MOF).

HLA-DR expression on peripheral monocytes was analyzed by flow cytometry, the ex vivo endotoxin-stimulated TNFα synthesis of whole blood, and the serum levels of IL-6, IL-10, procalcitonin (PCT), and CRP were analyzed by ELISA in 16 severely injured patients with an ISS >25.

Initially after trauma elevated serum levels of IL-6, IL-10, and PCT were found, while TNFα-producing capacity and HLA-DR expression on monocytes decreased. In patients with MOF a further decrease of HLA-DR expression on days 3–4 after injury was observed accompanied by elevated levels of IL-10 at this time point. However, the TNFα-producing capacity was even enhanced in patients with MOF in the 2nd week after trauma. Later PCT levels were also higher in patients with MOF.

Monitoring of immunological parameters after severe injury is useful to identify mediator constellations that are associated with the development and clinical course of MOF even in extremely injured patients.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum, Essen

    S. Lendemans, C. Waydhas, D. Nast-Kolb & S. Flohé

  2. Institut für Immunologie, Universitätsklinikum, Essen

    E. Kreuzfelder

  3. Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum, Hufelandstraße 55, 45122, Essen

    S. Lendemans

Authors
  1. S. Lendemans
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  2. E. Kreuzfelder
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  3. C. Waydhas
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  4. D. Nast-Kolb
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  5. S. Flohé
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Correspondence to S. Lendemans.

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Diese Forschungsarbeit wurde unterstützt durch das Förderprogramm IFORES der Universität Essen und DFG FL 353/2-1.

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Lendemans, S., Kreuzfelder, E., Waydhas, C. et al. Verlauf und prognostische Bedeutung immunologischer Funktionsparameter nach schwerem Traum. Unfallchirurg 107, 203–210 (2004). https://doi.org/10.1007/s00113-004-0729-7

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  • DOI: https://doi.org/10.1007/s00113-004-0729-7

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