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화상 및 감염환자에서 과립백혈구의 화학주성에 관한 연구

Other Titles
 Evaluation on the clinical applicability of polymorphonuclear leukocyte chemotaxis in patients with bacterial infection 
Authors
 조장환 
Issue Date
1983
Description
의학과/박사
Abstract
[한글] 수술후 병발하는 감염증은 협의의 병원감염으로 크게 두가지 신체적 장애를 초래하게 된다. 첫째, 혈독증을 유발하거나 조직손상을 일으킴으로 패혈증을 야기시키게되며 다른 하나는 국소적인 장애로서 창상치유의 지연, 이차적 출혈 및 창상파열등의 장애를 초래한 다. 급성염증에서 백혈구의 수적증가와 형태학적 분포는 임상적의의가 크다. 그러나 염증이 진행되고 패혈증등이 병발하였을 때 외견상으로 회복기와 같은 백혈구 과다증의 소실 및 백혈구 감소증을 보이게 된다. 이같은 중증의 감염증에서 백혈구의 수적의의는 소실되고 급기야는 사망에까지 이르게 된다. 생체는 피부와 점막으로 덮여있어 외계로부터 세균침입을 막고 있다. 일단 생체내로 세균이 침입하면 숙주 방어기전으로 염증반응이 일어나며, 과립백혈구, 특히 다핵형 백혈구의 일련의 연대반응 즉 골수내에서의 생산과 혈류내로 유출이 일어나며, 화학주성, 식균 작용, 세포의 살균 및 배설이 일어난다. 과립백혈구의 화학주성은 일찍이 가토의 안구전방내에 국소자극으로 염증을 유발시킴으로 백혈구이동을 관찰하였으며 자극부위을 향하여 백혈구가 일정방향으로 움직이는 운동성에 대한 여러 학자들의 연구가 행하여 졌다. 이러한 현상은 병균이침입한 병소에 식균 세포들이 모이게 되는 숙주방어기전의 하나로 실험관내 검사법으로 모세혈관법, 도말표본법 및 배양법들이 이용되어 왔다. 최근에 와서 membrane filter chamber 법이 개발된 이래 화학주성의 양적관찰이 가능케 되었다. 이 방법은 수용성화학주성유인인자를 사용하여 간편하고 재현성이 높으나 실험세포의 여과막 표면에 부착, 소공크기와 통로의 불규칙성 및 세포의 탈락등으로 실험결과에 영향을 미친다. 따라서 무작위성운동과 화학주성의 비교에 차질이 오게 된다. 한천배지하에서 과립백혈구 화학주성의 측정법은 보다 신속하고, 소량의 혈액을 소요하고, 경제성 및 재현성이 높으며 나아가 무작위성운동과 화학주성의 감별판정이 가능하게 되었다. 급성 감염증 환자에서 과립 백혈구의 화학주성장애는 여러연구자들에 의하여 보고된바 있으며 특히 화상환자에서 감염은 화상초기이후 주된 사망 요인이다. 이들 화상환자에서도 과립백혈구 화학 주성의 저하를 관찰한 보고가 많다. 그러나 패혈증 및 세균감염이 있는 환자의 예후를 판정함에 있어서 과립백혈구 화학주성장애에 관한 보고는 별로 없다. 이에 저자는 15예의 정상건강인 및 28예의 화상환자와 128예의 수술환자를 대상으로 수술전후 화농성감염이 발생한 환자에서 과립백혈구 화학주성의 변화를 시기적으로 반복 실시하여 이들 환자들의 임상결과와 비교 관찰함으로서 환자의 경과 및 예후 판정과 또한 감염증 및 패혈증의 조기진단적 가치가 있는지 알아보고자 본 실험을 실시하여 아래와 같은 결과를 얻었다. 1. 정상건강인과 수술후 합병증이 유발하지 않은 수술환자군에서 과립백혈구 화학주성은 그 차이를 관찰할 수 없었다. 2. 수술후 합병증 즉 창상감염, 호흡기감염 및 패혈증이 유발된 환자에서의 과립백혈구 화학주성은 의의있는 감소를 보였으며 특히 임상증상 및 검사소견의 이상이 발현되기 1내지 2일이전에 감소됨을 관찰하였다. 그러나 대량 신선혈 수혈군에서 화학주성이 정상에 가깝게 또는 그 이상으로 증가됨을 관찰하였다. 3. 수술군과 화상환자의 생존 환자군에서의 화학주성과 사망환자에서 화학주성의 최종검사 비교는 현저한 차이를 관찰할 수 있었다. 4. 과립백혈구 화학주성기능은 혈액배양에서 세균을 검출할 수 있었던 패혈증 환자의 혈청처리로 저하됨을 관찰하였다. 이상의 결과로 미루어 보아 과립백혈구 화학주성의 측정은 수술후 감염 및 화상환자의 예후판정에 의의있는 방법으로 사료되는 바이다. Evaluation on the Clinical Applicability of Polymorphonuclear Leukocyte Chemotaxis in Patients with Bacterial Infection Chang Hwan Cho Department of Medical Science The Graduate School Medicine, Yonsei University (Directed by Professor Joo Deuk Kim, M.D.) The initial inflammatory response to bacterial invasion of the body is critical as a determinant of the outcome of infection. Animal studies have demonstrated that prompt infiltration of phagocytic cells into an area of organism os essential of multiplication of the organism is to be suppressed and generalized infection prevented (Alexander, 1974; MacLean, 1975; Quie and Cates, 1977; Ward et al,. 1968). Since chemotaxis of leukocytes was first noted in excised rabbit ocular tissues, a variety of methods have been devised for the study of the unidirectional movement of leukocytes toward a chemotactic stimulus. This phenomenon, considered to be one of the mechanisms by which phagocytic cells are attracted to an area of bacterial invasion, was also found to occur in vitro when leukocytes were placed in a capillary tube (Ketchel and favour, 1955; McCall et al., 1971), between a slide and coverslip (McCutcheon, et al., 1934;Ramsey, 1972; Zigmond, 1974), or on a coverslip incubated in humid chamber (Harris, 1953; Ramsey, 1972; Repo et al., 1978; Zigmond, 1974; Zigmond and Hirsch, 1973). Introduction of the membrane filer chamber method (Boyden, 1962) facilitated the study of leukocyte chemotaxis. Using this chamber, soluble chemotactic substances were simple to in introduce and quantitation of the response became more easier and more reproducible. However, the results obtained using the Boyden chamber are affected by several factors such as cell adhesion to the filter material and tortuosity and size of the pore channels. These factors prevent simple comparison of spontaneous and directed cell movement. Measurement of leukocyte chemotaxis under agarose (Nelson et al., 1975) offers several advantages over assays of chemotaxis using the Boyden method. The agarose method is more raid, easier to quantitate, requires only small amounts of blood. Furthermore, with this agarose method, both chemotaxis and spontaneous migration of leukocytes can be distinguished and measured simultaneously. Functional defects of leukocyte chemotaxis have been described in patients during active bacterial infection (McCall et al., 1971; Wilkinson, 1980). Sepsis is a critical cause of death in patients with burn injuty. The leukocyte chemotaxis has also been shown to be abnormal following burn injuty (Fikrig et al., 1977; Grogan and Miller, 1973; Warden et al., 1974,1975). However, no previous study has shown the significance of the abnormal leukocyte chemotaxis in prediction the prognosis of patients with bacterial infection. with or without sepsis. The present study has attempted to examine the granulocyte chemotaxis in 28 patients with burn injury and 128 patients with bacterial infection before of after surgical manipulations compared with granulocyte chemotaxis in 15 healthy controls. Analysis of changes of granulocyte chemotaxis reveals that; 1. No significant difference was observed in granulocyte chemotaxis between healthy controls and operative patients without infection. 2. In patients with surgical complications such as wound infection, pulmonary complication and sepsis, the granulocyte chemotaxis was significantly decreased, especially in one or two days before the appearance of clinical and/or laboratory abnormalities. But it was significantly increased toward normal value or more when large amount of fresh whole blood was given. 3. The granulocyte chemotaxis in patients who underwent operation and who had burn injuries was significantly different between survivors and nonsurvivors. 4. The chemotaxis of granulocytes was markedly inhibited by serum from a septic patient who has positive blood culture. These data suggest that the granulocyte chetaxis is a reliable method in prediction the prognosis in cases with complications of bacterial infection.
[영문] The initial inflammatory response to bacterial invasion of the body is critical as a determinant of the outcome of infection. Animal studies have demonstrated that prompt infiltration of phagocytic cells into an area of organism os essential of multiplication of the organism is to be suppressed and generalized infection prevented (Alexander, 1974; MacLean, 1975; Quie and Cates, 1977; Ward et al,.1968). Since chemotaxis of leukocytes was first noted in excised rabbit ocular tissues, a variety of methods have been devised for the study of the unidirectional movement of leukocytes toward a chemotactic stimulus. This phenomenon, considered to be one of the mechanisms by which phagocytic cells are attracted to an area of bacterial invasion, was also found to occur in vitro when leukocytes were placed in a capillary tube (Ketchel and favour, 1955; McCall et al., 1971), between a slide and coverslip (McCutcheon, et al., 1934;Ramsey, 1972; Zigmond, 1974), or on a coverslip incubated in humid chamber (Harris, 1953; Ramsey, 1972; Repo et al., 1978; Zigmond, 1974; Zigmond and Hirsch, 1973). Introduction of the membrane filer chamber method (Boyden, 1962) facilitated the study of leukocyte chemotaxis. Using this chamber, soluble chemotactic substances were simple to in introduce and quantitation of the response became more easier and more reproducible. However, the results obtained using the Boyden chamber are affected by several factors such as cell adhesion to the filter material and tortuosity and size of the pore channels. These factors prevent simple comparison of spontaneous and directed cell movement. Measurement of leukocyte chemotaxis under agarose (Nelson et al., 1975) offers several advantages over assays of chemotaxis using the Boyden method. The agarose method is more raid, easier to quantitate, requires only small amounts of blood. Furthermore, with this agarose method, both chemotaxis and spontaneous migration of leukocytes can be distinguished and measured simultaneously. Functional defects of leukocyte chemotaxis have been described in patients during active bacterial infection (McCall et al., 1971; Wilkinson, 1980). Sepsis is a critical cause of death in patients with burn injuty. The leukocyte chemotaxis has also been shown to be abnormal following burn injuty (Fikrig et al., 1977; Grogan and Miller, 1973; Warden et al., 1974,1975). However, no previous study has shown the significance of the abnormal leukocyte chemotaxis in prediction the prognosis of patients with bacterial infection. with or without sepsis. The present study has attempted to examine the granulocyte chemotaxis in 28 patients with burn injury and 128 patients with bacterial infection before of after surgical manipulations compared with granulocyte chemotaxis in 15 healthy controls. Analysis of changes of granulocyte chemotaxis reveals that; 1. No significant difference was observed in granulocyte chemotaxis between healthy controls and operative patients without infection. 2. In patients with surgical complications such as wound infection, pulmonary complication and sepsis, the granulocyte chemotaxis was significantly decreased, especially in one or two days before the appearance of clinical and/or laboratory abnormalities. But it was significantly increased toward normal value or more when large amount of fresh whole blood was given. 3. The granulocyte chemotaxis in patients who underwent operation and who had burn injuries was significantly different between survivors and nonsurvivors. 4. The chemotaxis of granulocytes was markedly inhibited by serum from a septic patient who has positive blood culture. These data suggest that the granulocyte chetaxis is a reliable method in prediction the prognosis in cases with complications of bacterial infection.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117059
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2. 학위논문 > 1. College of Medicine (의과대학) > 박사
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