Stromps Jan-Philipp, Fuchs Paul, Demir Erhan, Grieb Gerrit, Reuber Kai, Pallua Norbert
From the *Department of Plastic Surgery, Hand Surgery, Burn Center University Hospital RWTH Aachen, Pauwelsstrasse, Germany; and †Department of Plastic Surgery, Hand Surgery, Burn Center University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Germany.
J Burn Care Res. 2015 Mar-Apr;36(2):e55-61. doi: 10.1097/BCR.0000000000000108.
The objective of this study was to evaluate the role of intraalveolar tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in a combination of skin burn and smoke inhalation injuries because this combined trauma is associated with an increased morbidity and mortality compared with either of these traumas alone. We used a standardized small animal model (rats n = 84) to investigate the early intraalveolar excretion of TNF-α during the first one, three, and six hours after a singular skin burn injury, singular smoke inhalation injury, and a combination involving both the traumas. The data were compared with the data from control rats that only received preparation and mechanical ventilation. The TNF-α serum levels and intraalveolar IL-6 concentrations were also measured. One hour after trauma, there was a significant difference in the TNF-α concentration between the controls and both the singular traumas (control vs burn P < .0444 and control vs smoke P < .005) and between the inhalation injury and the combined trauma (smoke vs burn + smoke P < .0084). After three and six hours, no significant differences among the groups were observed. Compared with the controls, both the singular skin burn and smoke inhalation injuries led to increased intraalveolar TNF-α excretion, whereas the combined trauma showed the least intraalveolar TNF-α levels at three and six hours post-trauma. These findings differed from the serum TNF-α levels. Compared with the IL-6 levels, we observed a negative correlation within the intraalveolar cytokine concentrations after one hour (r = -.809), three hours (r = -.627), and six hours (r = -.746). This study confirms the importance of the intraalveolar cytokine reaction in the early posttraumatic stage after a combined burn and inhalation injury. The differences between the combined and singular traumas indicate that TNF-α plays a role in the immunologic hyporesponsiveness of the lung and therefore in the systemic pathophysiological pathway, that often leads to patient mortality. In addition, an inverse correlation between TNF-α and IL-6, both classical markers of inflammation, in the intraalveolar space was observed.
本研究的目的是评估肺泡内肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）在皮肤烧伤合并烟雾吸入性损伤中的作用，因为与单独的这两种创伤相比，这种复合创伤会导致发病率和死亡率增加。我们使用标准化的小动物模型（84只大鼠）来研究在单纯皮肤烧伤、单纯烟雾吸入性损伤以及两种创伤合并后的最初1小时、3小时和6小时内TNF-α的早期肺泡内排泄情况。将这些数据与仅接受准备和机械通气的对照大鼠的数据进行比较。还测量了TNF-α血清水平和肺泡内IL-6浓度。创伤后1小时，对照组与两种单一创伤组之间（对照组与烧伤组P < 0.0444，对照组与烟雾组P < 0.005）以及吸入性损伤组与复合创伤组之间（烟雾组与烧伤 + 烟雾组P < 0.0084）的TNF-α浓度存在显著差异。3小时和6小时后，各组之间未观察到显著差异。与对照组相比，单纯皮肤烧伤和烟雾吸入性损伤均导致肺泡内TNF-α排泄增加，而复合创伤在创伤后3小时和6小时显示出最低的肺泡内TNF-α水平。这些发现与血清TNF-α水平不同。与IL-6水平相比，我们观察到1小时（r = -0.809）、3小时（r = -0.627）和6小时（r = -0.746）后肺泡内细胞因子浓度呈负相关。本研究证实了肺泡内细胞因子反应在烧伤合并吸入性损伤后创伤后早期阶段的重要性。复合创伤与单一创伤之间的差异表明，TNF-α在肺部免疫低反应性中起作用，因此在常常导致患者死亡的全身病理生理途径中起作用。此外，在肺泡内空间观察到TNF-α和IL-6（两种经典的炎症标志物）之间呈负相关。
