Hajri Tahar, Gharib Mohamed, Kaul Sanjeev, Karpeh Martin S
From the Department of Surgery (T.H., M.G., M.S.K.) and Trauma/Surgical Critical Care and Injury Prevention Unit (S.K.), Hackensack University Medical Center, Hackensack, New Jersey.
J Trauma Acute Care Surg. 2017 Sep;83(3):507-519. doi: 10.1097/TA.0000000000001610.
Adipose tissue is an endocrine organ that plays a critical role in immunity and metabolism by virtue of a large number of hormones and cytokines, collectively termed adipokines. Dysregulation of adipokines has been linked to the pathogenesis of multiple diseases, but some questions have arisen concerning the value of adipokines in critical illness setting. The objective of this review was to evaluate the associations between blood adipokines and critical illness outcomes.
PubMed, CINAHL, Scopus, and the Cochrane Library databases were searched from inception through July 2016 without language restriction. Studies reporting the associations of adipokines, leptin, adiponectin, resistin, and/or visfatin with critical illness outcomes mortality, organ dysfunction, and/or inflammation were included.
A total of 38 articles were selected according to the inclusion/exclusion criteria of the study. Significant alterations of circulating adipokines have been reported in critically ill patients, some of which were indicative of patient outcomes. The associations of leptin and adiponectin with critical illness outcomes were not conclusive in that blood levels of both adipokines did not always correlate with the illness severity scores or risks of organ failure and mortality. By contrast, studies consistently reported striking increase of blood resistin and visfatin, independently of the critical illness etiology. More interestingly, increased levels of these adipokines were systematically associated with severe inflammation, and high incidence of organ failure and mortality.
There is strong evidence to indicate that increased levels of blood resistin and visfatin are associated with poor outcomes of critically ill patients, including higher inflammation, and greater risk of organ dysfunction and mortality.
Systematic review, level III.
脂肪组织是一个内分泌器官，凭借大量统称为脂肪因子的激素和细胞因子在免疫和代谢中发挥关键作用。脂肪因子失调与多种疾病的发病机制有关，但在危重病情况下脂肪因子的价值出现了一些问题。本综述的目的是评估血液中脂肪因子与危重病结局之间的关联。
检索了PubMed、CINAHL、Scopus和Cochrane图书馆数据库，检索时间从建库至2016年7月，无语言限制。纳入报告脂肪因子、瘦素、脂联素、抵抗素和/或内脂素与危重病结局（死亡率、器官功能障碍和/或炎症）之间关联的研究。
根据研究的纳入/排除标准共选择了38篇文章。据报道，危重病患者循环脂肪因子有显著改变，其中一些提示患者结局。瘦素和脂联素与危重病结局的关联尚无定论，因为这两种脂肪因子的血液水平并不总是与疾病严重程度评分或器官衰竭及死亡风险相关。相比之下，研究一致报告血液抵抗素和内脂素显著增加，与危重病病因无关。更有趣的是，这些脂肪因子水平升高与严重炎症、器官衰竭高发生率和死亡率系统性相关。
有强有力的证据表明，血液抵抗素和内脂素水平升高与危重病患者的不良结局相关，包括更高的炎症反应、更大的器官功能障碍风险和死亡率。
系统评价，III级。
