Department of Cardiology, Helsinki University Hospital, Helsinki, Finland.
Department of Clinical Chemistry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Scand J Clin Lab Invest. 2020 Dec;80(8):640-643. doi: 10.1080/00365513.2020.1824297. Epub 2020 Sep 23.
The concentrations of several diagnostic markers have been found to increase dramatically in critically ill patients with a severe disturbance of normal physiological homeostasis, without indication of the diseases they are normally associated with. To prevent false diagnoses and inappropriate treatments of critically ill patients, it is important that the markers aiding the selection of second-line treatments are evaluated in such patients and not only in the healthy population and patients with diseases the markers are associated with. The levels of trypsinogen isoenzymes, the trypsin inhibitor serine peptidase inhibitor Kazal type 1 (SPINK1), hCG and hCGβ, which are used as pancreatitis and cancer markers, were analyzed by immunoassays from serum samples of 17 adult patients who have undergone surgery of the ascending aorta during hypothermic circulatory arrest (HCA) with optional selective cerebral perfusion. Highly elevated levels of trypsinogen-1, -2 and -3, SPINK1 and hCGβ were observed in patients after HCA. This was accompanied by increased concentrations of S100β and NSE. In conclusion, this study highlights the importance of critically evaluating the markers used for aiding selection of second line of treatments in critically ill patients.
几种诊断标志物的浓度在严重生理稳态紊乱的重症患者中急剧升高，而没有提示它们通常与哪些疾病相关。为了防止对重症患者进行误诊和不适当的治疗，重要的是评估有助于选择二线治疗的标志物在这些患者中的作用，而不仅仅是在健康人群和标志物相关疾病患者中进行评估。通过免疫分析方法，从 17 名接受低温循环停止（HCA）期间升主动脉手术的成年患者的血清样本中分析了胰蛋白酶原同工酶、胰蛋白酶抑制剂丝氨酸肽酶抑制剂 Kazal 型 1（SPINK1）、hCG 和 hCGβ 的水平，该手术可选择选择性脑灌注。在 HCA 后患者中观察到胰蛋白酶原-1、-2 和-3、SPINK1 和 hCGβ 的水平高度升高。这伴随着 S100β 和 NSE 浓度的增加。总之，本研究强调了在重症患者中批判性评估用于辅助选择二线治疗标志物的重要性。
