Dahl Benny, Schiødt Frank V, Ott Peter, Wians Frank, Lee William M, Balko Jody, O'Keefe Grant E
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
Crit Care Med. 2003 Jan;31(1):152-6. doi: 10.1097/00003246-200301000-00024.
Clinical and experimental studies suggest that the proteins of the extracellular actin scavenger system have a role in the pathophysiological processes taking place in critically ill and injured patients. Circulating levels of Gc-globulin and gelsolin are reduced shortly after severe trauma, and admission levels of Gc-globulin are associated with survival. Herein, we sought to measure the association between admission levels of Gc-globulin and postinjury organ dysfunction and infection. We also wanted to describe the serial changes in Gc-globulin in these severely injured patients.
Prospective cohort.
Intensive care unit at a county hospital that serves as a level one trauma center.
Ninety-eight consecutive trauma victims admitted to the intensive care unit for >24 hrs during a 4-month period.
Circulating levels of Gc-globulin were measured by using immunonephelometry. All patients were evaluated daily to obtain the necessary data for assessment of organ dysfunction and sepsis. The median Gc-globulin concentration at admission was 127 mg/L in patients who developed severe multiple organ dysfunction compared with 184 mg/L in patients who did not (p =.001). The admission level of Gc-globulin was comparable to known risk factors such as age and injury severity score, regarding development of organ dysfunction. Plasma concentrations of Gc-globulin remained significantly lower in patients who developed respiratory failure and sepsis, compared with patients who did not develop these complications (p =.02 and p=.015, respectively).
Admission plasma concentration of Gc-globulin is lower in patients who develop organ dysfunction and sepsis after traumatic injury. These data, combined with the work of others, support the hypothesis that actin release and depletion of the extracellular actin scavenger system proteins are associated with, and may contribute in part to, the complications of sepsis and organ dysfunction, particularly respiratory failure and thrombocytopenia.
临床和实验研究表明，细胞外肌动蛋白清除系统的蛋白质在危重症和受伤患者发生的病理生理过程中起作用。严重创伤后不久，Gc球蛋白和凝溶胶蛋白的循环水平会降低，且Gc球蛋白的入院水平与生存率相关。在此，我们试图测量Gc球蛋白入院水平与伤后器官功能障碍及感染之间的关联。我们还想描述这些严重受伤患者Gc球蛋白的系列变化情况。
前瞻性队列研究。
一家作为一级创伤中心的县医院的重症监护病房。
在4个月期间连续98名入住重症监护病房超过24小时的创伤受害者。
采用免疫比浊法测量Gc球蛋白的循环水平。每天对所有患者进行评估，以获取评估器官功能障碍和脓毒症所需的数据。发生严重多器官功能障碍的患者入院时Gc球蛋白浓度中位数为127mg/L，未发生者为184mg/L（p = 0.001）。就器官功能障碍的发生而言，Gc球蛋白的入院水平与年龄和损伤严重程度评分等已知危险因素相当。与未发生这些并发症的患者相比，发生呼吸衰竭和脓毒症的患者血浆Gc球蛋白浓度仍显著较低（分别为p = 0.02和p = 0.015）。
创伤后发生器官功能障碍和脓毒症的患者入院时血浆Gc球蛋白浓度较低。这些数据，结合其他研究成果，支持以下假设：肌动蛋白释放和细胞外肌动蛋白清除系统蛋白质的消耗与脓毒症和器官功能障碍的并发症相关，且可能在一定程度上导致这些并发症，尤其是呼吸衰竭和血小板减少症。
