Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University Frankfurt am Main, 60590 Frankfurt, Germany.
Immunobiology. 2013 Apr;218(4):470-6. doi: 10.1016/j.imbio.2012.06.002. Epub 2012 Jun 9.
Infectious complications frequently occur after major trauma, leading to increased morbidity and mortality. Thrombin-activatable fibrinolysis inhibitor (TAFI), a procarboxypeptidase in plasma, plays a dual role in regulating both coagulation and inflammation. Activated TAFI (TAFIa) has broad anti-inflammatory properties due to its inactivation of active inflammatory mediators (anaphylatoxins C3a and C5a, bradykinin, osteopontin).
The purpose of this study was to determine if TAFI plays a role in the development of inflammatory complications after major trauma.
PATIENTS/METHODS: Upon arrival at the emergency department (ED), plasma levels of TAFI and TAFIa were measured in 26 multiple traumatized patients for 10 consecutive days. Systemic levels of inflammatory mediators, including interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and leukocytes were determined.
Fifteen patients developed pneumonia and/or sepsis (compl) and 11 had no complications (wo compl). Overall injury severity and age were comparable in both groups. Complications occurred approximately 5 days after trauma. IL-6 increased on day 5, whereas CRP, PCT and leukocytes started to increase on day 6 in the compl-group. Upon arrival at the ED and on days 1 and 4, TAFI levels were significantly lower in the compl-group compared to the wo compl-group (p=0.0215). Similarly, TAFIa was significantly lower on day 4 in the compl-group than in the wo compl-group (p=0.049).
This pilot study shows that TAFI levels are inversely correlated with inflammation-associated development of complications after major trauma.
重大创伤后常发生感染性并发症，导致发病率和死亡率增加。凝血酶激活的纤溶抑制物（TAFI）是血浆中的一种前羧肽酶，在调节凝血和炎症方面发挥双重作用。激活的 TAFI（TAFIa）由于其失活活性炎症介质（过敏毒素 C3a 和 C5a、缓激肽、骨桥蛋白）而具有广泛的抗炎特性。
本研究旨在确定 TAFI 是否在重大创伤后炎症并发症的发展中发挥作用。
患者/方法：在急诊科（ED），对 26 名多发伤患者连续 10 天每天测量 TAFI 和 TAFIa 的血浆水平。测定全身炎症介质水平，包括白细胞介素 6（IL-6）、降钙素原（PCT）、C 反应蛋白（CRP）和白细胞。
15 名患者发生肺炎和/或脓毒症（compl），11 名患者无并发症（wo compl）。两组患者的总体损伤严重程度和年龄相当。并发症发生在创伤后约 5 天。IL-6 在第 5 天增加，而 CRP、PCT 和白细胞在 compl 组第 6 天开始增加。在到达 ED 时以及第 1 天和第 4 天，compl 组的 TAFI 水平明显低于 wo compl 组（p=0.0215）。同样，compl 组第 4 天的 TAFIa 水平也明显低于 wo compl 组（p=0.049）。
这项初步研究表明，TAFI 水平与重大创伤后炎症相关并发症的发生呈负相关。
