血浆ADAMTS13活性与急性生理学及慢性健康状况评分系统II（APACHE II）评分平行，反映了重症急性胰腺炎患者的早期预后指标。

Plasma ADAMTS13 activity parallels the APACHE II score, reflecting an early prognostic indicator for patients with severe acute pancreatitis.

作者信息

Morioka Chie, Uemura Masahito, Matsuyama Tomomi, Matsumoto Masanori, Kato Seiji, Ishikawa Masatoshi, Ishizashi Hiromichi, Fujimoto Masao, Sawai Masayoshi, Yoshida Motoyuki, Mitoro Akira, Yamao Junichi, Tsujimoto Tatsuhiro, Yoshiji Hitoshi, Urizono Yasuyuki, Hata Michiaki, Nishino Kenji, Okuchi Kazuo, Fujimura Yoshihiro, Fukui Hiroshi

机构信息

Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan.

出版信息

Scand J Gastroenterol. 2008;43(11):1387-96. doi: 10.1080/00365520802179933.

DOI:10.1080/00365520802179933

PMID:18609162

Abstract

OBJECTIVE

Severe acute pancreatitis (SAP) frequently progresses to pancreatitis-associated multiorgan failure (MOF) with high mortality. Decreased plasma ADAMTS13 activity (ADAMTS13:AC) results in the accumulation of unusually large von Willebrand factor multimers (UL-VWFM) and the formation of platelet thrombi, ultimately leading to MOF. The purpose of the study was to investigate the potential role of ADAMTS13:AC in the severity of SAP.

MATERIAL AND METHODS

Plasma ADAMTS13:AC and its related parameters were sequentially determined in 13 SAP patients. ADAMTS13:AC was determined by the chromogenic act-ELISA.

RESULTS

Within 1 or 2 days after admission, ADAMTS13:AC was lower in SAP patients (mean 28%) than in healthy controls (99%), and gradually recovered in the 11 survivors but further decreased in the 2 non-survivors. Patients with higher sepsis-related organ failure assessment (SOFA) scores showed lower ADAMTS13:AC than those without these scores. The inhibitor against ADAMTS13 was undetectable. On day 1, von Willebrand factor antigen (VWF:Ag) was higher (402%, p<0.001) in SAP patients than in controls (100%). VWF:Ag gradually decreased in the survivors, except in the 3 patients needing a necrosectomy, but remained high in the non-survivors. ADAMTS13:AC was inversely correlated with the APACHE II score (r=-0.750, p<0.005), and increased plasma concentrations of interleukin 6 (IL-6) and IL-8 at admission. UL-VWFM-positive patients had lower ADAMTS13:AC and decreased serum calcium concentrations, but higher VWF:Ag and IL-8 concentrations than UL-VWFM-negative patients.

CONCLUSIONS

Plasma ADAMTS13:AC was closely related to the APACHE II score. This intimate relationship may serve as an early prognostic indicator for SAP patients. The imbalance between decreased ADAMTS13:AC and increased UL-VWFM could contribute to SAP pathogenesis through enhanced thrombogenesis.

摘要

目的

重症急性胰腺炎（SAP）常进展为胰腺炎相关性多器官功能衰竭（MOF），死亡率很高。血浆中含血小板结合蛋白基序的金属蛋白酶13活性（ADAMTS13:AC）降低会导致超大血管性血友病因子多聚体（UL-VWFM）蓄积及血小板血栓形成，最终导致多器官功能衰竭。本研究旨在探讨ADAMTS13:AC在SAP严重程度中的潜在作用。

材料与方法

对13例SAP患者依次测定血浆ADAMTS13:AC及其相关参数。采用发色底物法ELISA测定ADAMTS13:AC。

结果

入院后1或2天内，SAP患者的ADAMTS13:AC低于健康对照者（平均28%比99%），11例存活患者的ADAMTS13:AC逐渐恢复，但2例非存活患者的ADAMTS13:AC进一步降低。脓毒症相关器官功能衰竭评估（SOFA）评分较高的患者，其ADAMTS13:AC低于无这些评分的患者。未检测到ADAMTS13的抑制剂。第1天，SAP患者的血管性血友病因子抗原（VWF:Ag）高于对照组（402%，p<0.001）（对照组为100%）。除3例需要行坏死组织清除术的患者外，存活患者的VWF:Ag逐渐降低，但非存活患者的VWF:Ag仍维持在较高水平。ADAMTS13:AC与急性生理与慢性健康状况评分系统II（APACHE II）评分呈负相关（r=-0.750，p<0.005），且与入院时血浆白细胞介素6（IL-6）和白细胞介素8浓度升高有关。UL-VWFM阳性患者的ADAMTS13:AC较低，血清钙浓度降低，但VWF:Ag和IL-8浓度高于UL-VWFM阴性患者。