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Die Unfallchirurgie

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01.10.2005 | Originalien

Die Bedeutung der Zytokine in der posttraumatischen Entzündungsreaktion

verfasst von: Dr. F. Hildebrand, H.-C. Pape, C. Krettek

Erschienen in: Die Unfallchirurgie | Ausgabe 10/2005

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Zusammenfassung

Veränderungen der Immunantwort nach Polytrauma, posttraumatischer Sepsis und operativen Eingriffen stellen eine physiologische Reaktion des Organismus zur Aufrechterhaltung der Homöostase dar. Das Ausmaß dieser immunologischen Reaktionen korreliert dabei mit der Schwere des Gewebeschadens sowie dem Ausmaß der Hämorrhagie und Ischämie. Zytokine werden als integraler Bestandteil der Immunantwort angesehen.

Die lokale Freisetzung von pro- und antiinflammatorischen Zytokinen nach Polytrauma kann systemische Organreaktionen beeinflussen und damit den klinischen Verlauf maßgeblich beeinträchtigen. Bei einem Überwiegen der proinflammatorischen Zytokine kommt es zu einer systemischen Entzündungsreaktion („systemic inflammatory response syndrome“, SIRS), wohingegen eine Überproduktion antiinflammatorischer Mediatoren in einer Immunsuppression mit einem erhöhten Risiko infektiologischer Komplikationen resultieren kann. Sowohl das SIRS als auch die Immunsuppression scheinen bei der Entwicklung eines „Multiorgandysfunktionssyndroms“ (MODS) eine signifikante Rolle zu spielen.

Tumornekrosefaktor-α (TNF-α), Interleukin–1β (IL-1β), Interleukin-6 (IL-6) and Interleukin-8 (IL-8) stellen die wesentlichen proinflammatorischen Zytokine für den posttraumatischen Verlauf dar. Diese Zytokine vermitteln eine Vielzahl von teilweise auch üperlappenden und additiven Effekten. TNF-α and IL-1β sind frühe Regulatoren der Immunantwort, und beide können die Freisetzung sekundärer Zytokine, wie IL-6 und IL-8 induzieren. Interleukin-10 (IL-10) ist ein antiinflammatorisches Zytokin, das die Synthese proinflammatorischer Mediatoren reduziert. Andere wichtige antiinflammatorische Mediatoren sind lösliche TNF-Rezeptoren (TNF-RI und -RII) und der IL-1-Rezeptorantagonist (IL-1ra), die mit den Wirkungen des TNF-α and IL-1β interferieren.

Die frühe Einschätzung der Prognose und des klinischen Zustands der polytraumatisierten Patienten stellt sich als äußerst schwierig dar. In einer Vielzahl von Studien sind daher Zytokinkonzentrationen im posttraumatischen Verlauf bestimmt worden, um prognostische Marker für das Outcome der Patienten zu identifizieren. Des Weiteren wurden ebenso systemische Zytokinspiegel bestimmt, um den günstigsten Zeitpunkt für den chirurgischen Eingriff nach einem Polytrauma festzulegen und das Ausmaß des Eingriffs zu quantifizieren. Das Ziel dieser Arbeit ist es, den aktuellen Wissensstand bezüglich der Assoziation zwischen posttraumatischen Zytokinsynthese und der Entwicklung von Komplikationen zusammenzufassen. Ein verbessertes Verständnis dieser Mechanismen könnte zur Erstellung neuer diagnostischer und therapeutischer Behandlungsstrategien im klinischen Alltag beitragen.

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Titel: Die Bedeutung der Zytokine in der posttraumatischen Entzündungsreaktion
verfasst von: Dr. F. Hildebrand
H.-C. Pape
C. Krettek
Publikationsdatum: 01.10.2005
Verlag: Springer-Verlag
Erschienen in: Die Unfallchirurgie / Ausgabe 10/2005
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI: https://doi.org/10.1007/s00113-005-1005-1

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