Abstract：
Cellular debris resulting from large trauma might overwhelm the scavenger mechanisms and lead to autoimmune reactions. We analysed whether a major well-defined trauma in humans induces laboratory signs of transient autoimmunity in the months after the insult. We included 50 patients with pertrochanteric femur fracture undergoing intramedullary nail osteosynthesis in a prospective cohort study and followed them at 3-4 days, 6 weeks, 12 weeks and 12 months postoperatively. By standard techniques, we assessed levels of total immunoglobulins, anti-nuclear antibodies (ANA), anti-cardiolipin antibodies, anti-dsDNA antibodies and anti-C1q antibodies, as well as antibodies against cytomegalovirus (CMV) as a control. Blood leukocyte differential and lymphocyte subpopulations were determined at baseline and in the first two postoperative samples. The mean age of the patients reached 80.1 years, and 23 (46%) completed all visits. Serum concentrations of total IgG, IgM and IgA increased at all follow-up time points. The ANA fluorescence light intensity units increased at 12 weeks and 12 months postoperatively (p < 0.0001), but the proportion of ANA-positive patients did not change (35%). The values of anti-C1q mildly increased at all follow-up visits, but not the ratio to total IgG. Anti-dsDNA remained negative in all patients, and anti-cardiolipin IgG/IgM antibodies did not change. Anti-CMV IgG antibodies increased significantly at all follow-up visits, without change in the ratio to total IgG. Flow cytometry showed an increased proportion of B-cells 3-4 days postoperatively. In conclusion, major musculoskeletal trauma in elderly patients induces a generalized non-specific increase in immunoglobulin production without laboratory signs for enhanced systemic autoimmunity.
摘要：
大创伤导致的细胞碎片可能会压倒清除剂机制并导致自身免疫反应。我们分析了人类严重明确的创伤是否会在侮辱后的几个月内引起短暂自身免疫的实验室体征。我们在一项前瞻性队列研究中纳入了50例股骨转子骨折患者，这些患者接受了髓内钉接骨术，并在3-4天进行了随访。6周,术后12周和12个月。通过标准技术，我们评估了总免疫球蛋白的水平，抗核抗体（ANA），抗心磷脂抗体,抗dsDNA抗体和抗C1q抗体，以及针对巨细胞病毒（CMV）的抗体作为对照。在基线和前两个术后样本中确定血液白细胞差异和淋巴细胞亚群。患者的平均年龄达到80.1岁,23人(46%)完成所有访问。血清总IgG浓度，IgM和IgA在所有随访时间点增加。ANA荧光强度单位在术后12周和12个月增加（p<0.0001），但ANA阳性患者的比例没有变化(35%).在所有随访中，抗C1q值略有增加，但不是总IgG的比例。抗dsDNA在所有患者中保持阴性，和抗心磷脂IgG/IgM抗体没有变化。抗CMVIgG抗体在所有随访中显著增加，与总IgG的比例没有变化。流式细胞术显示术后3-4天B细胞比例增加。总之,老年患者的主要肌肉骨骼创伤引起免疫球蛋白产生的普遍非特异性增加，而没有增强的全身性自身免疫的实验室体征。
