Yeh Li-Chun, Huang Ping-Wun, Hsieh Kuan-Hsian, Wang Chung-Hsuan, Kao Yi-Kai, Lin Tzu-Hsiang, Lee Xiao-Lun
Emergency Department, Changhua Show-Chwan Memorial Hospital.
Department of Surgery, Zuoying branch of Kaohsiung Armed Forces General Hospital.
Tohoku J Exp Med. 2017 Nov;243(3):187-193. doi: 10.1620/tjem.243.187.
Acute lung injury (ALI) is one of the complications of severe sepsis, causing sudden deaths. However, information regarding predictive factors for the onset of ALI in severe sepsis is limited. Growth arrest-specific gene 6 (Gas6) is secreted by endothelial cells and is important for the activation of endothelium during inflammation. This study aimed to investigate the predictive effect of plasma Gas6 in patients with severe sepsis. Collection of plasma samples was carried out from 129 participants with severe sepsis following with or without ALI development. We found that the elevated levels of Gas6, interleukin-6 and -8 (IL-6 and IL-8) in plasma were associated with the ALI development (P = 0.003, 0.002, and 0.004, respectively). We also observed the robust correlation between the plasma level of Gas6 and the following ALI development to adjustment for sepsis and administration of vasopressor. Between patients with ALI (n = 18) and those without ALI (n = 111), Gas6 and the Lung Injury Prediction Score (LIPS) showed promising discrimination (AUROC, 0.74 and 0.68, respectively), and in combination with these two indexes, the AUROC was increased to 0.86 (vs. 0.74, P = 0.05), while soluble receptor for advanced glycation end products (sRAGE) and Willebrand factor (vWF) in plasma showed no predictive value for of ALI. Collectively, our findings indicate that higher levels of Gas6 in plasma are obviously correlated with ALI development. An early increase in the plasma Gas6 level suggests that endothelial injury is a key link in the pathogenesis of ALI.
急性肺损伤（ALI）是严重脓毒症的并发症之一，可导致猝死。然而，关于严重脓毒症中ALI发病预测因素的信息有限。生长停滞特异性基因6（Gas6）由内皮细胞分泌，在炎症过程中对内皮细胞的激活起重要作用。本研究旨在探讨血浆Gas6对严重脓毒症患者的预测作用。收集了129例伴有或不伴有ALI发生的严重脓毒症参与者的血浆样本。我们发现，血浆中Gas6、白细胞介素-6和-8（IL-6和IL-8）水平升高与ALI的发生相关（P分别为0.003、0.002和0.004）。我们还观察到，在调整脓毒症和血管升压药使用情况后，血浆Gas6水平与随后的ALI发生之间存在显著相关性。在ALI患者（n = 18）和无ALI患者（n = 111）之间，Gas6和肺损伤预测评分（LIPS）显示出良好的鉴别能力（曲线下面积分别为0.74和0.68），将这两个指标结合起来，曲线下面积增加到0.86（对比0.74，P = 0.05），而血浆中晚期糖基化终末产物可溶性受体（sRAGE）和血管性血友病因子（vWF）对ALI无预测价值。总体而言，我们的研究结果表明，血浆中较高水平的Gas6与ALI的发生明显相关。血浆Gas6水平的早期升高表明内皮损伤是ALI发病机制中的关键环节。
