title: Decreased levels of perforin-positive lymphocytes are associated with posttraumatic complications in patients with major trauma.
abstract: OBJECTIVE
  Posttraumatic immune disorder can cause complications including systemic inflammatory response syndrome (SIRS) and multiple-organ dysfunction syndrome (MODS). Cytotoxic granules containing perforin and granzyme-B (GrB) are released by cytotoxic CD8(+) T lymphocytes, NK and γδT cells after major trauma. This prospective clinical study was designed to analyze the association between these immune components and complications after major trauma.
  
  
  METHODS
  We retrospectively studied 48 patients aged between 16 and 65 years admitted within 90min of major trauma (Injury Severity Score>16) and surviving beyond 7 days, and 20 healthy controls. Blood samples were drawn on admission and after 1, 3 and 7 days. CD8(+) T, NK and γδT cell counts in peripheral blood and the levels of perforin and GrB in these cells were analyzed by flow cytometry. Clinical aspects of MODS and SIRS were recorded daily.
  
  
  RESULTS
  CD8(+) T cell counts were not significantly different in patients with SIRS or uncomplicated group, but were depressed in the MODS group after trauma. However, NK cell counts in patients with MODS were significantly depressed only at day 7 after injury, and γδT cell counts were significantly depressed after trauma. Perforin levels in CD8(+) T, NK and γδT cells in patients with MODS were depressed after trauma. GrB levels in NK, CD8(+) T and γδT cells in patients with MODS were significantly depressed at 3 and 7 days post trauma.
  
  
  CONCLUSIONS
  Posttraumatic MODS is associated with early, sustained, and severe depression of lymphocytes.
authors.affiliation: Department of Emergency Medicine, The 97th Hospital of PLA, Xuzhou 221000, China. Electronic address: HuarongSCI@163.com.
authors.forename: Rong
authors.initials: R
authors.lastname: Hua
authors.affiliation: Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou 221000, China.
authors.forename: Yongmei
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Central Laboratory, The 97th Hospital of PLA, Xuzhou 221000, China.
authors.forename: Fuxing
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Central Laboratory, The 97th Hospital of PLA, Xuzhou 221000, China.
authors.forename: Zhonghai
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Trauma Central, The 97th Hospital of PLA, Xuzhou 221000, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.affiliation: Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou 221000, China.
authors.forename: Boming
authors.initials: B
authors.lastname: Shao
authors.affiliation: Department of Emergency Medicine, The 97th Hospital of PLA, Xuzhou 221000, China.
authors.forename: Shangjing
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Trauma Central, The 97th Hospital of PLA, Xuzhou 221000, China.
authors.forename: Yujing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Central Laboratory, The 97th Hospital of PLA, Xuzhou 221000, China.
authors.forename: Xiaoting
authors.initials: X
authors.lastname: Lv
mesh_terms: D000293:Adolescent; D000328:Adult; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism*; D002681:China / Q000453:epidemiology; D005260:Female; D005786:Gene Expression Regulation; D006801:Humans; D015601:Injury Severity Score; D007694:Killer Cells, Natural / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D009104:Multiple Trauma / Q000150:complications / Q000276:immunology / Q000378:metabolism*; D054353:Perforin / Q000378:metabolism*; D011446:Prospective Studies; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000276:immunology / Q000503:physiopathology*
chemical_list: D054353:Perforin
keywords: Cytotoxic T cells; Granzyme-B; Major trauma; Multiple-organ dysfunction syndrome; Perforin; Systemic inflammatory response syndrome