硫酸乙酰肝素蛋白聚糖-1 血浆浓度升高与 20%白蛋白的毛细血管渗漏增加无关。

Elevated Plasma Concentrations of Syndecan-1 Do Not Correlate With Increased Capillary Leakage of 20% Albumin.

机构信息

From the Research Unit, Södertälje Hospital, Södertälje, Sweden.

Karolinska Institutet at Danderyds Hospital (KIDS).

出版信息

Anesth Analg. 2021 Mar 1;132(3):856-865. doi: 10.1213/ANE.0000000000005315.

DOI:10.1213/ANE.0000000000005315

PMID:33350618

Abstract

BACKGROUND

Preclinical experiments show that an inflammatory reaction causes degradation of the endothelial glycocalyx layer and accelerated capillary leakage of albumin and fluid. The hypothesis in the present study was that elevated plasma concentrations of glycocalyx degradation products are associated with greater capillary leakage in humans.

METHODS

This open clinical trial involved administration of an intravenous infusion of 20% albumin at 3 mL/kg over 30 minutes to 15 postburn patients who showed an activated inflammatory response. Blood samples and urine were collected for 300 minutes. The plasma concentrations of 2 biomarkers of glycocalyx degradation-syndecan-1 and heparan sulfate-were measured at 0, 60, and 300 minutes and compared to the capillary leakage of albumin and fluid obtained by mass balance calculations and population kinetic analysis.

RESULTS

Patients were studied at 7 days (median) after a burn injury that covered 15% (maximum 48%) of the body surface area. The median plasma syndecan-1 concentration was 71 (25th-75th percentiles, 41-185) ng/mL. The 2 patients with highest values showed 2279 and 2395 ng/mL (normal 15 ng/mL). Heparan sulfate concentrations averaged 915 (673-1539) ng/mL. The infused amount of albumin was 57 (48-62) g, and 6.3 (5.1-7.7)% of that leaked from the plasma per hour.Linear correlation analysis of the relationship between the 10logarithm of the mean syndecan-1 and the albumin leakage showed a slope coefficient of -1.3 (95% confidence interval [CI], -3.6 to 1.0) and a correlation coefficient of -0.33 (P = .24). The kinetic analysis revealed that syndecan-1 served as a statistically significant covariate to the albumin leakage, but the relationship was inverse (power exponent -0.78, 95% CI, -1.50 to -0.05; P < .02). Heparan sulfate levels did not correlate with the capillary leakage of albumin or fluid in any of the analyses.

CONCLUSIONS

A raised plasma concentration of syndecan-1 alone cannot be extrapolated to indicate increased capillary leakage of albumin and fluid.

摘要

背景

临床前实验表明，炎症反应会导致内皮糖萼层降解，并加速白蛋白和液体的毛细血管渗漏。本研究的假设是，血浆中糖萼降解产物的浓度升高与人类的毛细血管渗漏增加有关。

方法

本开放性临床试验涉及给 15 例烧伤后表现出炎症反应激活的患者静脉输注 20%白蛋白，剂量为 3 mL/kg，持续 30 分钟。在 300 分钟内采集血样和尿液。在 0、60 和 300 分钟时测量 2 种糖萼降解生物标志物（硫酸乙酰肝素和 syndecan-1）的血浆浓度，并通过质量平衡计算和群体动力学分析将其与白蛋白和液体的毛细血管渗漏进行比较。

结果

患者在烧伤后 7 天（中位数）进行研究，烧伤面积占体表面积的 15%（最大 48%）。中位血浆 syndecan-1 浓度为 71（25 至 75 百分位，41 至 185）ng/mL。2 例血浆值最高的患者分别为 2279 和 2395 ng/mL（正常 15 ng/mL）。硫酸乙酰肝素浓度平均为 915（673-1539）ng/mL。输注的白蛋白量为 57（48-62）g，每小时有 6.3%（5.1-7.7%）从血浆中漏出。对平均 syndecan-1 的 10 对数与白蛋白渗漏之间关系的线性相关分析显示，斜率系数为-1.3（95%置信区间 [CI]，-3.6 至 1.0），相关系数为-0.33（P =.24）。动力学分析表明，syndecan-1 是白蛋白渗漏的统计学显著协变量，但关系是相反的（幂指数-0.78，95%CI，-1.50 至-0.05；P <.02）。硫酸乙酰肝素水平在任何分析中均与白蛋白或液体的毛细血管渗漏无关。