Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Pediatric Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Shock. 2019 Sep;52(3):340-346. doi: 10.1097/SHK.0000000000001267.
Angiopoietin-1 (Agpt-1) and Agpt-2 are cytokine regulators of vascular endothelial integrity. Elevated plasma Agpt-2 levels and ratios of Agpt-2:Agpt-1 are associated with adverse outcomes in adult trauma and pediatric sepsis populations. However, the behavior of the angiopoietins after pediatric trauma has not been characterized, and their relationship to endothelial glycocalyx damage, indicated by plasma syndecan-1 (Syn-1) levels, has not been established.
We performed a secondary analysis of prospectively collected data from 52 pediatric trauma patients and 12 control patients at a level one pediatric trauma center from 2013 to 2016. We measured Agpt-1, Agpt-2, and Syn-1 levels from plasma taken upon hospital arrival and 24 h after admission. Angiopoietin levels were compared to controls, and the correlation between Agpt-2 and Syn-1 was assessed.
Plasma Agpt-1 and Agpt-2 levels are elevated immediately after pediatric trauma compared with controls. At 24 h, trauma patients demonstrated significantly elevated plasma Agpt-2:Agpt-1 ratios relative to controls due to decline of Agpt-1 levels to near that of controls. Higher 24-h Agpt-2 levels are associated with more hypoperfusion, and elevated 24-h Agpt-2:Agpt-1 ratios are associated with adverse clinical outcomes. Significant positive correlations between Agpt-2 and Syn-1 upon admission and at 24 h after injury were identified.
Our findings suggest dysregulation of circulating angiopoietins after pediatric trauma that may be linked to endothelial glycocalyx injury. Larger prospective studies are needed to validate these findings and determine the relationship of Agpt-2 with other markers of endotheliopathy.
血管生成素-1（Agpt-1）和 Agpt-2 是血管内皮完整性的细胞因子调节剂。血浆 Agpt-2 水平升高和 Agpt-2:Agpt-1 比值升高与成人创伤和儿科脓毒症患者的不良结局相关。然而，儿科创伤后血管生成素的行为尚未得到描述，其与内皮糖萼损伤的关系（以血浆 syndecan-1（Syn-1）水平表示）也尚未建立。
我们对 2013 年至 2016 年期间在一家一级儿科创伤中心的 52 名儿科创伤患者和 12 名对照患者的前瞻性收集数据进行了二次分析。我们测量了入院时和入院后 24 小时的血浆中 Agpt-1、Agpt-2 和 Syn-1 水平。将 Angiopoietin 水平与对照组进行比较，并评估 Agpt-2 和 Syn-1 之间的相关性。
与对照组相比，儿科创伤后即刻血浆 Agpt-1 和 Agpt-2 水平升高。在 24 小时时，由于 Agpt-1 水平下降至接近对照组水平，创伤患者的血浆 Agpt-2:Agpt-1 比值显著升高。较高的 24 小时 Agpt-2 水平与灌注不足有关，而升高的 24 小时 Agpt-2:Agpt-1 比值与不良临床结局相关。在入院时和受伤后 24 小时，Agpt-2 与 Syn-1 之间存在显著的正相关。
我们的研究结果表明，儿科创伤后循环血管生成素失调，这可能与内皮糖萼损伤有关。需要更大规模的前瞻性研究来验证这些发现，并确定 Agpt-2 与其他内皮病变标志物的关系。
