Whalen M J, Doughty L A, Carlos T M, Wisniewski S R, Kochanek P M, Carcillo J A
Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh, PA, USA.
Crit Care Med. 2000 Jul;28(7):2600-7. doi: 10.1097/00003246-200007000-00070.
To determine concentrations of circulating adhesion molecules endothelial (E)-selectin, intercellular adhesion molecule (ICAM)-1, and vascular cell adhesion molecule (VCAM)-1 in children with sepsis-induced multiple organ failure (MOF), and to determine associations among increased concentrations of these circulating adhesion molecules and important outcome measures.
Prospective study.
University pediatric intensive care unit.
A total of 77 consecutive children with sepsis and 14 acutely ill children without sepsis.
Plasma E-selectin, ICAM-1, and VCAM-1 concentrations and organ failure index (indicating number of failed organ systems) were determined in 77 children on days 1 and 3 of sepsis, and in 14 control children on pediatric intensive care unit day 1. Multivariate logistic regression analysis was used to determine associations between adhesion molecule concentrations and clinically relevant outcome measures.
Plasma concentrations of E-selectin, ICAM-1, and VCAM-1 were increased in children with sepsis vs. control on day 1 (p < .05). Plasma VCAM-1 (but not ICAM-1 or E-selectin) was increased in children with more than three organ failures vs. children with less than three organ failures (p < .05). Plasma ICAM-1 and VCAM-1 (but not E-selectin) concentrations independently predicted number of organs failed and development of more than three organ failures. Plasma ICAM-1 and VCAM-1 also predicted mortality and development of sequential (pulmonary/hepatic/renal) MOF (p < .05).
The pronounced and persistent increase in plasma VCAM-1 and ICAM-1 that occurs in children with sepsis and persistent MOF may indicate a phenotypic change in endothelium toward a more proinflammatory state. Alternatively, the source for these adhesion molecules may be activated leukocytes and other cell types. Future studies are required to determine the role of ICAM-1 and VCAM-1 in the pathogenesis of sepsis-induced MOF.
测定脓毒症诱发多器官功能衰竭（MOF）患儿循环中内皮（E）-选择素、细胞间黏附分子（ICAM）-1和血管细胞黏附分子（VCAM）-1的浓度，并确定这些循环黏附分子浓度升高与重要预后指标之间的关联。
前瞻性研究。
大学儿科重症监护病房。
共77例连续的脓毒症患儿和14例无脓毒症的急性病患儿。
在脓毒症第1天和第3天测定77例患儿以及在儿科重症监护病房第1天测定14例对照患儿的血浆E-选择素、ICAM-1和VCAM-1浓度以及器官功能衰竭指数（表明衰竭器官系统的数量）。采用多因素逻辑回归分析确定黏附分子浓度与临床相关预后指标之间的关联。
脓毒症患儿第1天血浆E-选择素、ICAM-1和VCAM-1浓度高于对照组（p < 0.05）。与器官功能衰竭少于3个的患儿相比，器官功能衰竭超过3个的患儿血浆VCAM-1（而非ICAM-1或E-选择素）升高（p < 0.05）。血浆ICAM-1和VCAM-1（而非E-选择素）浓度独立预测了衰竭器官数量以及超过3个器官功能衰竭的发生。血浆ICAM-1和VCAM-1还预测了死亡率以及序贯性（肺/肝/肾）MOF的发生（p < 0.05）。
脓毒症和持续性MOF患儿血浆VCAM-1和ICAM-1显著且持续升高，这可能表明内皮细胞向更促炎状态的表型改变。或者，这些黏附分子的来源可能是活化的白细胞和其他细胞类型。需要进一步研究以确定ICAM-1和VCAM-1在脓毒症诱发MOF发病机制中的作用。
