Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
J Surg Res. 2010 Nov;164(1):e163-71. doi: 10.1016/j.jss.2010.05.004. Epub 2010 Jun 1.
Severe sepsis, septic shock, and resulting organ failure appear as the most common cause of death in intensive care medicine. Inflammatory mediators (interleukin-6/IL-6), cell adhesion molecules (intercellular adhesion molecule-1/ICAM-1, vascular cell adhesion molecule-1/VCAM-1), and redox active substances (manganese superoxide dismutase/MnSOD, macrophage migration inhibitory factor/MIF) must be considered to be central hubs in the inflammatory process. However, their exact pathophysiologic function and prognostic value are still poorly understood.
In total, 133 individuals (87 patients with severe sepsis or septic shock, 28 postoperative patients after major abdominal surgery, 18 healthy volunteers) were enrolled in the study. Blood samples from septic patients were collected within 24 h after the time of sepsis diagnosis, and 48 and 120 h later; samples from healthy volunteers were collected once, and samples from postoperative patients once immediately after surgery. In all patients we measured plasma levels of IL-6, sICAM-1, sVCAM-1, MnSOD, and MIF using enzyme linked immunosorbent assay (ELISA) kits.
Healthy volunteers and postoperative patients showed comparable levels of cell adhesion molecules. Furthermore, their redox system was activated in a comparable manner, whereas in postoperative patients IL-6 was significantly elevated. Plasma levels of inflammatory mediators, cell adhesion molecules and redox active substances were significantly elevated in septic patients. In patients with sepsis who had died, plasma levels of MIF and MnSOD were significantly elevated in comparison with survivors.
Our results therefore demonstrate that redox active substances may play an important role in the septic inflammatory response. MIF and MnSOD appear to be early predictors for survival in septic patients.
严重脓毒症、感染性休克和由此导致的器官衰竭是重症监护医学中最常见的死亡原因。炎症介质（白细胞介素 6/IL-6）、细胞黏附分子（细胞间黏附分子 1/ICAM-1、血管细胞黏附分子 1/VCAM-1）和氧化还原活性物质（锰超氧化物歧化酶/MnSOD、巨噬细胞移动抑制因子/MIF）被认为是炎症过程中的核心枢纽。然而，它们的确切病理生理功能和预后价值仍知之甚少。
本研究共纳入 133 名个体（87 名严重脓毒症或感染性休克患者、28 名大型腹部手术后患者、18 名健康志愿者）。脓毒症患者的血液样本在脓毒症诊断后 24 小时内采集，并在 48 小时和 120 小时后再次采集；健康志愿者的样本仅采集一次，术后患者的样本在手术后立即采集一次。在所有患者中，我们使用酶联免疫吸附试验（ELISA）试剂盒测量了血浆中白细胞介素 6（IL-6）、可溶性细胞间黏附分子 1（sICAM-1）、可溶性血管细胞黏附分子 1（sVCAM-1）、MnSOD 和 MIF 的水平。
健康志愿者和术后患者的细胞黏附分子水平相当。此外，他们的氧化还原系统以类似的方式被激活，而术后患者的白细胞介素 6（IL-6）显著升高。脓毒症患者的炎症介质、细胞黏附分子和氧化还原活性物质的血浆水平显著升高。与存活患者相比，死亡患者的血浆 MIF 和 MnSOD 水平显著升高。
因此，我们的研究结果表明氧化还原活性物质可能在脓毒症炎症反应中发挥重要作用。MIF 和 MnSOD 似乎是脓毒症患者生存的早期预测指标。
