Gäddnäs Fiia, Koskela Marjo, Koivukangas Vesa, Risteli Juha, Oikarinen Aarne, Laurila Jouko, Saarnio Juha, Ala-Kokko Tero
Department of Anesthesiology, Division of Intensive Care, Oulu University Hospital, FI-90029, Oulu, Finland.
Crit Care. 2009;13(2):R53. doi: 10.1186/cc7780. Epub 2009 Apr 9.
Sepsis-related multiple organ dysfunction is a common cause of death in the intensive care unit. The effect of sepsis on markers of tissue repair is only partly understood. The aim of this study was to measure markers of collagen synthesis and degradation during sepsis and investigate the association with disease severity and outcome.
Forty-four patients with severe sepsis participated in the study and 15 volunteers acted as controls. Blood samples were collected for 10 days after the first sepsis-induced organ dysfunction and after three and six months. Procollagen type I and III aminoterminal propeptides (PINP and PIIINP) and cross-linked telopeptides of type I collagen (ICTP) were measured.
The PIIINP concentration was elevated in the septic patients (8.8 microg/L, 25th to 75th percentile = 6.8 to 26.0) when compared with controls (3.0 microg/L, 25th to 75th percentile = 2.7 to 3.3; P < 0.001) on day one. Maximum serum PIIINP concentrations during sepsis were higher in non-survivors compared with survivors (26.1 microg/L, 25th to 75th percentile = 18.7 to 84.3; vs. 15.1 microg/L, 25th to 75th percentile = 9.6 to 25.5; P = 0.033) and in multiple organ failure (MOF) compared with multiple organ dysfunction syndrome (MODS) (24.2 ug/L, 25th to 75th percentile = 13.4 to 48.2; vs. 8.9 microg/L, 25th to 75th percentile = 7.4 to 19.4; P = 0.002). Although the PINP values of the septic patients remained within the laboratory reference values, patients with MOF had higher values than patients with MODS (79.8, 25th to 75th percentile = 44.1 to 150.0; vs.40.4, 25th to 75th percentile = 23.6 to 99.3; P = 0.007). Day one ICTP levels were elevated in septic patients compared with the controls (19.4 microg/L, 25th to 75th percentile = 12.0 to 29.8; vs. 4.1 microg/L, 25th to 75th percentile = 3.4 to 5.0; P < 0.001).
Markers of collagen metabolism are increased in patients with severe sepsis and can be investigated further as markers of disease severity and outcome.
脓毒症相关的多器官功能障碍是重症监护病房常见的死亡原因。脓毒症对组织修复标志物的影响仅部分为人所知。本研究的目的是测量脓毒症期间胶原蛋白合成和降解的标志物，并研究其与疾病严重程度及预后的关系。
44例严重脓毒症患者参与本研究，15名志愿者作为对照。在首次脓毒症诱发的器官功能障碍后以及3个月和6个月后采集血样，检测I型和III型前胶原氨基端前肽（PINP和PIIINP）以及I型胶原交联端肽（ICTP）。
与对照组相比，脓毒症患者在第1天的PIIINP浓度升高（8.8μg/L，第25至75百分位数为6.8至26.0），而对照组为（3.0μg/L，第25至75百分位数为2.7至3.3；P<0.001）。脓毒症期间非幸存者的血清PIIINP最高浓度高于幸存者（26.1μg/L，第25至75百分位数为18.7至84.3；相比之下，幸存者为15.1μg/L，第25至75百分位数为9.6至25.5；P=0.033），多器官功能衰竭（MOF）患者高于多器官功能障碍综合征（MODS）患者（24.2μg/L，第25至75百分位数为13.4至48.2；相比之下，MODS患者为8.9μg/L，第25至75百分位数为7.4至19.4；P=0.002）。虽然脓毒症患者的PINP值仍在实验室参考值范围内，但MOF患者的值高于MODS患者（79.8，第25至75百分位数为44.1至150.0；相比之下，MODS患者为40.4，第25至75百分位数为23.6至99.3；P=0.007）。与对照组相比，脓毒症患者第1天的ICTP水平升高（19.4μg/L，第25至75百分位数为12.0至29.8；相比之下，对照组为4.1μg/L，第25至75百分位数为3.4至5.0；P<0.001）。
严重脓毒症患者的胶原蛋白代谢标志物升高，可作为疾病严重程度和预后的标志物进一步研究。
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