Buttenschoen K, Fleischmann W, Haupt U, Kinzl L, Buttenschoen D C
Department of General Surgery, University of Ulm, Germany.
J Trauma. 2000 Feb;48(2):241-5. doi: 10.1097/00005373-200002000-00008.
Translocation of endotoxins was demonstrated for multiple injury but not for minor trauma such as isolated malleolar fractures. Major trauma leads to substantial changes in the plasma concentration of acute-phase proteins. However, isolated malleolar fractures are minor trauma. The objective of this study was to elucidate the kinetics of endotoxemia and the ability of plasma to inactivate endotoxin of patients operated on malleolar fractures and to demonstrate the early time course of the acute-phase proteins C-reactive protein, transferrin, alpha1-acid glycoprotein, haptoglobin, and interleukin-6 and to correlate them with the amount of endotoxemia.
Thirty patients with malleolar fractures were operated on within 6 hours after injury. Blood was collected immediately after admission and regularly up to 96 hours after surgery.
Preoperative endotoxin plasma levels were increased compared with that of healthy individuals (0.05 +/- 0.017 vs. 0.02 EU/mL). Endotoxemia peaked 0.5 hours after the surgical procedure at 0.096 +/- 0.03 (p < 0.05 vs. healthy) and decreased to almost normal values after 24 hours. The ability of the plasma to inactivate endotoxin was significantly reduced after the surgical procedure compared with normal subjects (recovery, 0.17 +/- 0.028 EU/mL vs. 0.04 +/- 0.01 EU/mL; p < 0.05). Plasma interleukin-6 peaked 0.5 hours postoperatively (114 +/- 11 pg/mL, p < 0.05 vs. healthy), decreasing thereafter. C-Reactive protein peaked at 45 +/- 5 mg/mL (p < 0.05) 48 hours after injury. Transferrin decreased significantly postoperatively (2.41 +/- 0.12 mg/mL vs. pre-OP 2.65 +/- 0.1 mg/mL) and remained on this level for 96 hours. Both, alpha1-acid glycoprotein and haptoglobin increased postoperatively until day 4 (0.78 +/- 0.06 mg/mL to 1.15 +/- 0.08 mg/mL and 1.51 +/- 0.12 mg/mL to 3.24 +/- 0.22 mg/mL). There was no correlation between endotoxemia and the concentrations of the acute-phase proteins and interleukin-6.
Surgery for malleolar fractures is associated with temporary endotoxemia and temporary reduced endotoxin inactivation capacity of the plasma. The injury and the surgical procedure leads to substantial changes in the plasma concentrations of acute-phase proteins. The relation between endotoxemia and acute-phase response is not dose dependent.
内毒素移位在多处损伤中得到证实，但在单纯踝关节骨折等轻度创伤中未得到证实。严重创伤会导致急性期蛋白血浆浓度发生显著变化。然而，单纯踝关节骨折属于轻度创伤。本研究的目的是阐明踝关节骨折手术患者内毒素血症的动力学以及血浆对内毒素的灭活能力，并展示急性期蛋白C反应蛋白、转铁蛋白、α1-酸性糖蛋白、触珠蛋白和白细胞介素-6的早期变化过程，并将它们与内毒素血症的程度相关联。
30例踝关节骨折患者在受伤后6小时内接受手术。入院后立即采血，并在术后定期采血直至96小时。
与健康个体相比，术前血浆内毒素水平升高（0.05±0.017 vs. 0.02 EU/mL）。内毒素血症在手术后0.5小时达到峰值，为0.096±0.03（与健康个体相比，p<0.05），并在24小时后降至几乎正常水平。与正常受试者相比，手术后血浆对内毒素的灭活能力显著降低（回收率，0.17±0.028 EU/mL vs. 0.04±0.01 EU/mL；p<0.05）。血浆白细胞介素-6在术后0.5小时达到峰值（114±11 pg/mL，与健康个体相比，p<0.05），此后下降。C反应蛋白在受伤后48小时达到峰值45±5 mg/mL（p<0.05）。转铁蛋白在术后显著下降（2.41±0.12 mg/mL vs.术前2.65±0.1 mg/mL），并在96小时内维持在该水平。α1-酸性糖蛋白和触珠蛋白在术后均升高，直至第4天（0.78±0.06 mg/mL至1.15±0.08 mg/mL和1.51±0.12 mg/mL至3.24±0.22 mg/mL）。内毒素血症与急性期蛋白和白细胞介素-6的浓度之间无相关性。
踝关节骨折手术与短暂的内毒素血症和血浆内毒素灭活能力暂时降低有关。损伤和手术操作导致急性期蛋白血浆浓度发生显著变化。内毒素血症与急性期反应之间的关系不是剂量依赖性的。
