RESUMO
The PHA-induced and serum levels of IFN-alpha and -gamma, TNF-alpha, IL-4, IL-6, IL-8, IL-RA, as well as CD3, CD4, CD8, CD20, CD56 lymphocytic subpopulations and serum IgG, IgM, and IgA were studied in 53 patients with multiple trauma to detect the most informative parameters of laboratory monitoring of the immunodeficiency developing during treatment. The stages of the study corresponded to the phases of development of an immune response: (1) an induction phase (days 1-4); (2) an immunoregulatory phase (days 5-10); (3) an effector phase (days 11-24). The findings suggest that at the early stage of the study, the drastic reduction was revealed in CD3, CD4 T-lymphocytic subpopulations, accompanied by inadequate humoral immunological parameters. By Stage 3 of the study, the majority of these parameters became normal; the serum levels of IgG and IgM remained lower only in patients with a fatal outcome. Throughout all the 3 stages of the study, the serum concentration of IFN-alpha remained in the almost normal ranges; there was no significant elevation in both the serum and induced levels of IL-4 either. The serum content of TNF-alpha in the examinees was significantly higher than the normal levels, by remaining virtually at the same level up to the end of treatment. The elevated serum levels of TNF-alpha were attended by its increased induction in vitro, without reducing up to Stage 3. From Stage 3, only some patients with a fatal outcome were observed to have the reduced induced and spontaneous levels of TNF-alpha. According to the findings, at Stage 1 of the study, the production of IFN-gamma in all patients was much increased, by significantly dropping by the end of treatment (by more than twice), without achieving, however, the normal levels, except the examinees with a fatal outcome, in whom the concentration of IFN-alpha increased or underwent no changes. A relationship was also found between the serum levels of IL-6 and IL-8 and the outcome of the disease: throughout the observation, their concentrations remained invariably high in patients with a fatal outcome whereas in those with a good outcome, there was a uniform decrease in the content of both cytokines by the end of the observation. Thus, the simultaneous increase in the levels of IFN-gamma, IL-6, IL-8, and TNF-alpha and accompanying reductions in CD3, CD4 and serum IgG, IgM are poor prognostic factors and may be used both as additional immunodiagnostic criteria and for immunotherapy monitoring in patients with polytrauma.
