Baker Todd A, Davis Christopher S, Bach Harold H, Romero Jacqueline, Burnham Ellen L, Kovacs Elizabeth J, Gamelli Richard L, Majetschak Matthias
Department of Surgery, Burn and Shock Trauma Institute, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois 60153, USA.
J Burn Care Res. 2012 Jan-Feb;33(1):57-64. doi: 10.1097/BCR.0b013e31823dc559.
The objective of the study was to determine whether the CXC chemokine receptor (CXCR) 4 ligands ubiquitin and stromal cell-derived factor (SDF)-1α are detectable in bronchoalveolar lavage fluid (BALF) after burn and inhalation injury and whether their concentrations in BALF are associated with injury severity, physiological variables, or clinical outcomes. BALF was obtained on hospital admission from 51 patients (48 ± 18 years) with burn (TBSA: 23 ± 24%) and inhalation injury (controls: 10 healthy volunteers, 42 ± 8 years). BALF was analyzed for total protein and for ubiquitin and SDF-1α by enzyme-linked immunosorbent assay. Ubiquitin/SDF-1α levels were normalized to total BALF protein content. The extent of inhalation injury was determined during bronchoscopy using a standardized scoring system. Percent TBSA, Baux scores, revised Baux scores, and clinical variables were documented. Ubiquitin and SDF-1α were detectable in 40% of normal BALF specimens. After injury, ubiquitin was detectable in 90% (P < .01 vs control) and SDF-1α in 10% of the specimens (P < .05 vs control). While SDF-1α levels were reduced in patients (P < .01), ubiquitin levels were increased (P < .01). Ubiquitin concentrations correlated inversely with grade of inhalation injury, revised Baux scores, and resuscitation fluid requirements (Spearman correlation coefficients [r]: -.3, -.33, and -.45, respectively). Ubiquitin levels correlated positively with arterial oxygenation at the time of bronchoscopy (r: .35). BALF levels of CXCR4 agonists are differentially regulated after burn and inhalation injury. Increases in BALF ubiquitin after inhalation injury may maintain CXCR4-mediated lung protection and repair processes. The finding that BALF ubiquitin decreased with higher grades of inhalation injury may provide a biological correlate for an insufficient local inflammatory response after severe inhalation injury.
本研究的目的是确定在烧伤和吸入性损伤后支气管肺泡灌洗液（BALF）中是否可检测到CXC趋化因子受体（CXCR）4配体泛素和基质细胞衍生因子（SDF）-1α，以及它们在BALF中的浓度是否与损伤严重程度、生理变量或临床结局相关。在入院时从51例烧伤（总体表面积：23±24%）和吸入性损伤患者（48±18岁）中获取BALF（对照组：10名健康志愿者，42±8岁）。通过酶联免疫吸附测定法分析BALF中的总蛋白、泛素和SDF-1α。将泛素/SDF-1α水平标准化为BALF总蛋白含量。在支气管镜检查期间使用标准化评分系统确定吸入性损伤的程度。记录总体表面积百分比、博克斯评分、修订的博克斯评分和临床变量。在40%的正常BALF标本中可检测到泛素和SDF-1α。损伤后，90%的标本中可检测到泛素（与对照组相比P<.01），10%的标本中可检测到SDF-1α（与对照组相比P<.05）。虽然患者的SDF-1α水平降低（P<.01），但泛素水平升高（P<.01）。泛素浓度与吸入性损伤分级、修订的博克斯评分和复苏液需求量呈负相关（斯皮尔曼相关系数[r]分别为-.3、-.33和-.45）。泛素水平与支气管镜检查时的动脉氧合呈正相关（r:.35）。烧伤和吸入性损伤后，BALF中CXCR4激动剂的水平受到不同调节。吸入性损伤后BALF中泛素增加可能维持CXCR4介导的肺保护和修复过程。吸入性损伤分级越高，BALF中泛素降低这一发现可能为严重吸入性损伤后局部炎症反应不足提供生物学关联。
