Gando Satoshi, Kameue Takashi, Matsuda Naoyuki, Sawamura Atsushi, Hayakawa Mineji, Kato Hirokatsu
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan.
Inflammation. 2004 Aug;28(4):237-44. doi: 10.1023/b:ifla.0000049049.81688.fe.
To determine the existence of a close link between inflammation and coagulation in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and to examine their prognostic value in the development of ARDS and clinical outcome, we made a prospective cohort study. The study subjects consisted of 57 patients: 19 patients with ARDS and 38 patients with ALI as defined by a Lung Injury Score of > or =2.5 and 1.0 to less than 2.5, respectively. According to the outcome, the patients were subdivided into the survivors and the nonsurvivors. Ten normal healthy volunteers served as control subjects. Plasma levels of soluble L-, P-, and E-selectins, intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), thrombomodulin (sTM), and neutrophil elastase were measured within 24 h after the diagnosis of ALI or ARDS. The number of systemic inflammatory response syndrome (SIRS) criteria being met by the patients and the disseminated intravascular coagulation (DIC) scores were determined simultaneously. The number of SIRS criteria and the DIC scores of the patients with ALI or ARDS showed high values, and more than half of the patients were complicated by DIC. The levels of sL-selectin in both groups of the patients were significantly lower than those of the control subjects. All other soluble adhesion molecules, neutrophil elastase, and sTM in the patients with ALI and ARDS were markedly elevated than those in the control subjects. The levels sICAM-1, sVCAM-1, and sTM in the ARDS patients significantly increased compared with the ALI patients. The number of SIRS criteria and the DIC scores in the nonsurvivors showed higher values than those in the survivors. In addition, we found significant differences in the levels of soluble adhesion molecules, neutrophil elastase, and sTM between the survivors and the nonsurvivors. In conclusion, we found a concurrent activation of both inflammation and coagulation in the patients with ALI or ARDS. The results also suggest that systemic activation of inflammation and coagulation associated with endothelial injury has prognostic value for the development of ARDS and poor outcome.
为了确定急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）患者炎症与凝血之间是否存在紧密联系，并研究它们在ARDS发生发展及临床结局中的预后价值，我们进行了一项前瞻性队列研究。研究对象包括57例患者：19例ARDS患者和38例ALI患者，分别根据肺损伤评分≥2.5和1.0至小于2.5来定义。根据结局，将患者分为幸存者和非幸存者。10名正常健康志愿者作为对照。在诊断ALI或ARDS后24小时内测量血浆中可溶性L-、P-和E-选择素、细胞间黏附分子-1（sICAM-1）、血管细胞黏附分子-1（sVCAM-1）、血栓调节蛋白（sTM）和中性粒细胞弹性蛋白酶的水平。同时确定患者符合全身炎症反应综合征（SIRS）标准的数量和弥散性血管内凝血（DIC）评分。ALI或ARDS患者的SIRS标准数量和DIC评分较高，超过半数患者并发DIC。两组患者的sL-选择素水平均显著低于对照受试者。ALI和ARDS患者的所有其他可溶性黏附分子、中性粒细胞弹性蛋白酶和sTM均明显高于对照受试者。ARDS患者的sICAM-1、sVCAM-1和sTM水平与ALI患者相比显著升高。非幸存者的SIRS标准数量和DIC评分高于幸存者。此外，我们发现幸存者和非幸存者之间可溶性黏附分子、中性粒细胞弹性蛋白酶和sTM水平存在显著差异。总之，我们发现ALI或ARDS患者炎症和凝血同时激活。结果还表明，与内皮损伤相关的炎症和凝血的全身激活对ARDS的发生发展和不良结局具有预后价值。
