Siemiatkowski Andrzej, Wereszczynska-Siemiatkowska Urszula, Mroczko Barbara, Galar Marzenna, Maziewski Tomasz
Departments of aAnaesthesiology and Intensive Therapy bGastroenterology and Internal Medicine cBiochemical Diagnostics dHaematology, Medical University of Bialystok, Bialystok, Poland.
Eur J Gastroenterol Hepatol. 2015 Jun;27(6):728-34. doi: 10.1097/MEG.0000000000000338.
To investigate the role of endothelial cell mediators, E-selectin (ES), intercellular adhesion molecule-1 (ICAM-1), tissue factor (TF), and von Willebrand factor (vWF), in the early phase of severe acute pancreatitis (SAP) complicated with respiratory failure [pancreatitis-associated lung injury (PALI)].
This study included 30 patients with SAP and 39 patients with PALI. Blood samples were taken from SAP and PALI patients on presenting to the hospital (day 1), and days 2, 3, 5, and 10. The relationship between blood concentrations of the studied endothelial mediators and lung function tests was analyzed.
PALI patients had significantly higher ES, ICAM-1, TF, and vWF blood levels than those with SAP as early as at admission and throughout the period studied. We found the highest concentration of ES on the second day, ICAM-1 and TF at admission, and vWF level on the fifth day. There were adverse correlations between ES, ICAM-1, TF, vWF concentrations, and the index of oxygenation--PaO2/FiO2 ratio (Rs=-0.385, Rs=-0.523, Rs=-0.505, Rs=-0.408, P<0.001, respectively). The most accurate prediction of PALI was provided by ICAM-1 and TF levels on the day of admission [areas under curve (AUCs): ES, 0.704; ICAM-1, 0.787; TF, 0.757; and vWF, 0.686].
Endothelium-related mediators ES, ICAM-1, TF, and vWF appear to participate in pancreatitis-associated lung injury. In SAP, the measurement of endothelial mediator levels (especially ICAM-1 and TF) may be used as an early prognostic indicator that would predict the development of respiratory failure and to monitor the severity of lung dysfunction.
探讨内皮细胞介质E选择素（ES）、细胞间黏附分子1（ICAM - 1）、组织因子（TF）和血管性血友病因子（vWF）在重症急性胰腺炎（SAP）合并呼吸衰竭[胰腺炎相关性肺损伤（PALI）]早期阶段的作用。
本研究纳入30例SAP患者和39例PALI患者。在患者入院当天（第1天）以及第2、3、5和10天采集SAP和PALI患者的血样。分析所研究的内皮介质血浓度与肺功能检查之间的关系。
PALI患者早在入院时及整个研究期间，其ES、ICAM - 1、TF和vWF的血水平均显著高于SAP患者。我们发现ES在第2天浓度最高，ICAM - 1和TF在入院时最高，vWF水平在第5天最高。ES、ICAM - 1、TF、vWF浓度与氧合指数——动脉血氧分压/吸入氧分数值（PaO2/FiO2）呈负相关（相关系数分别为Rs = -0.385、Rs = -0.523、Rs = -0.505、Rs = -0.408，P均<0.001）。入院当天ICAM - 1和TF水平对PALI的预测最为准确[曲线下面积（AUC）：ES为0.704；ICAM - 1为0.787；TF为0.757；vWF为0.686]。
内皮相关介质ES、ICAM - 1、TF和vWF似乎参与了胰腺炎相关性肺损伤。在SAP中，测量内皮介质水平（尤其是ICAM - 1和TF）可作为预测呼吸衰竭发生的早期预后指标，并用于监测肺功能障碍的严重程度。
