严重脓毒症患者皮肤胶原合成受抑。

Skin collagen synthesis is depressed in patients with severe sepsis.

机构信息

Department of Anaesthesiology, Division of Intensive Care, Oulu University Hospital, P.O. Box 21, FI-90029 Oulu, Finland.

出版信息

Anesth Analg. 2010 Jul;111(1):156-63. doi: 10.1213/ANE.0b013e3181e1db48. Epub 2010 May 19.

DOI:10.1213/ANE.0b013e3181e1db48

PMID:20484539

Abstract

BACKGROUND

Skin is an essential barrier in maintaining a stable internal environment. Adequate regenerative capacity is crucial to overcome the homeostatic challenges caused by a septic insult. In sepsis, coagulation and inflammation are activated to restore homeostasis, but it is not known whether sepsis also alters tissue regeneration processes such as skin collagen synthesis.

METHODS

In this prospective observational study, we measured aminoterminal propeptides of collagens I and III (PINP, PIIINP) from blister fluid of sepsis patients. Blister fluid was obtained from experimental blisters induced on intact abdominal skin 4 times: within the first 48 hours from the first organ failure, on the fifth day, and at 3 and 6 months thereafter. Forty-four patients with severe sepsis were enrolled. The median age was 63 years (25th-75th percentile, 53-71 years). The median Acute Physiology and Chronic Health Evaluation II score on admission was 26 (22-30). Thirty-day mortality was 25%. Fifteen healthy adults were used as controls.

RESULTS

Median PIIINP and PINP levels in septic patients were lower in comparison with controls in the first blister (40.8 microg/L [25th-75th percentile, 22.2-77.1 microg/L], P = 0.028 and 69.9 microg/L [32.4-112.7 microg/L], P < 0.001, respectively) and in the blister induced on day 5 (38.8 microg/L [19.9-68.5 microg/L], P < 0.001 and 90.0 [35.1-138.8 microg/L], P < 0.001, respectively). The survivors revealed an overexpression at 3 months, whereas normal values of PIIINP and PINP were reestablished at 6 months.

CONCLUSIONS

Skin collagen synthesis is depressed during severe sepsis and is followed by a compensatory response 3 and 6 months after the onset of sepsis.

摘要

背景

皮肤是维持稳定内环境的重要屏障。充足的再生能力对于克服脓毒症引起的内稳态挑战至关重要。在脓毒症中，凝血和炎症被激活以恢复内稳态，但尚不清楚脓毒症是否也会改变组织再生过程，如皮肤胶原合成。

方法

在这项前瞻性观察性研究中，我们测量了脓毒症患者水疱液中的 I 型和 III 型前胶原氨基末端肽（PINP、PIIINP）。水疱液是从完整腹部皮肤上的 4 次实验性水疱中获得的：在首次器官衰竭的前 48 小时内、第 5 天、此后的 3 个月和 6 个月。共纳入 44 例严重脓毒症患者。中位年龄为 63 岁（25 百分位数至 75 百分位数，53-71 岁）。入院时急性生理学和慢性健康评估 II 评分中位数为 26（22-30）。30 天死亡率为 25%。15 名健康成年人作为对照。

结果

与对照组相比，脓毒症患者的第 1 次水疱液中的 PIIINP 和 PINP 水平较低（40.8μg/L[25 百分位数至 75 百分位数，22.2-77.1μg/L]，P=0.028 和 69.9μg/L[32.4-112.7μg/L]，P<0.001）和第 5 天水疱液中的水平较低（38.8μg/L[19.9-68.5μg/L]，P<0.001 和 90.0μg/L[35.1-138.8μg/L]，P<0.001）。幸存者在 3 个月时表现出过度表达，而 PIIINP 和 PINP 的正常值在脓毒症发作后 6 个月时得到恢复。