创伤患者血清脂多糖结合蛋白浓度

Cunningham Steven C, Malone Debra L, Bochicchio Grant V, Genuit Thomas, Keledjian Kaspar, Tracy J Kathleen, Napolitano Lena M

Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.

Surg Infect (Larchmt). 2006 Jun;7(3):251-61. doi: 10.1089/sur.2006.7.251.

BACKGROUND

In low concentrations, lipopolysaccharide-binding protein (LBP), an acute-phase protein recognizing lipopolysaccharide (LPS), catalyzes its transfer to the cellular receptor consisting of CD14 and Toll-like receptor-4. Previous studies have documented increased serum LBP concentrations in patients with sepsis, systemic inflammatory response syndrome (SIRS), or acute pancreatitis and after cardiopulmonary bypass. No prior studies have examined LBP expression in trauma victims. We hypothesized that admission LBP plasma concentrations are predictive of outcome (mortality) in trauma. This study assessed time-dependent changes in serum LBP concentrations in trauma patients soon after injury.

METHODS

A prospective, single-institution, observational cohort study of 121 adult trauma patients (age > or =17 years) with moderate to severe injury who required hospitalization. The trauma patients were male in 79.6% of the cases and had a mean age of 43.0 +/- 20.6 years. The mean injury severity score (ISS) was 23 +/- 12, and the crystalloid resuscitation volume given in the first 24 h averaged 6,640 +/- 3,729 mL. Informed consent was obtained on admission, and blood samples were drawn on admission and at 24 h postadmission. Prospective data were collected for daily SIRS score, multiple organ dysfunction score (MODS), and sequential organ failure assessment (SOFA) score, complications, and outcomes. Plasma concentrations of LBP were measured by enzyme-linked immunosorbent assay.

RESULTS

Sixty patients (48.8% of the study cohort) required emergency surgical intervention and sustained a substantial intraoperative blood loss (mean 1,404 +/- 2,757 mL). The hospital mortality rate was 16.3% (20 patients). The mean intensive care unit stay was 8.9 +/- 16.4 days, and the hospital stay was 14.8 +/- 19.6 days. The patients had a significantly higher serum concentrations of LBP on admission (mean 28.0 +/- 25.3 mg/L; range 2-100 mg/L) than did control subjects (mean 6.2 +/- 2.1 mg/L; range 1.3-12.8 mg/L; p < 0.01), similar to the plasma concentrations previously reported in septic patients. A significant increase in LBP concentration was noted at 24 h (mean 72.3 +/- 45.7 mg/L; range 8-210 mg/L; p < 0.05). The admission LBP concentration was significantly greater in nonsurvivors than in survivors. However, after controlling for age and ISS, the admission LBP concentration did not predict death.

背景

在低浓度时，脂多糖结合蛋白（LBP）是一种识别脂多糖（LPS）的急性期蛋白，可催化其转移至由CD14和Toll样受体-4组成的细胞受体。既往研究记录了脓毒症、全身炎症反应综合征（SIRS）或急性胰腺炎患者以及体外循环术后血清LBP浓度升高。此前尚无研究检测创伤患者的LBP表达情况。我们推测创伤患者入院时的LBP血浆浓度可预测预后（死亡率）。本研究评估了创伤患者伤后不久血清LBP浓度随时间的变化。

方法

对121例需要住院治疗的中重度成年创伤患者（年龄≥17岁）进行一项前瞻性、单中心观察性队列研究。创伤患者中79.6%为男性，平均年龄为43.0±20.6岁。平均损伤严重度评分（ISS）为23±12，伤后24小时内晶体复苏液平均用量为6640±3729 mL。入院时获得知情同意，入院时及入院后24小时采集血样。前瞻性收集每日SIRS评分、多器官功能障碍评分（MODS）、序贯器官衰竭评估（SOFA）评分、并发症及预后数据。采用酶联免疫吸附测定法检测LBP的血浆浓度。

结果

60例患者（占研究队列的48.8%）需要紧急手术干预，术中失血量大（平均1404±2757 mL）。医院死亡率为16.3%（20例患者）。重症监护病房平均住院时间为8.9±16.4天，住院时间为14.8±19.6天。患者入院时血清LBP浓度（平均28.0±25.3 mg/L；范围2 - 100 mg/L）显著高于对照组（平均6.2±2.1 mg/L；范围1.3 - 12.8 mg/L；p < 0.01），与既往报道的脓毒症患者血浆浓度相似。24小时时LBP浓度显著升高（平均72.3±45.7 mg/L；范围8 - 210 mg/L；p < 0.05）。非存活者入院时LBP浓度显著高于存活者。然而，在控制年龄和ISS后，入院时LBP浓度不能预测死亡。