Lin Jian-Chang, Xu Zhao-Rong, Chen Zhao-Hong, Chen Xiao-Dong
Fujian Provincial Key Laboratory of Burn and Trauma, Fujian Burn Institute, Fujian Burn Medical Center, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian, China.
Burns. 2021 Sep;47(6):1322-1332. doi: 10.1016/j.burns.2020.11.016. Epub 2020 Dec 15.
Patients with severe burns often show systemic coagulation changes in the early stage and even develop extensive coagulopathy. Previous studies have confirmed that soluble TREM-like transcript-1 (sTLT-1) mediates a novel mechanism of haemostasis and thrombosis in inflammatory vascular injury. At present, the role of sTLT-1 in patients with severe burns is not well known.
To investigate the early association between sTLT-1 levels and markers of burn severity, coagulation disorders, endothelial permeability, shock and prognosis in patients with severe burns.
A prospective, observational study was conducted with 60 severe burn patients (divided into a death group and a survival group according to 30-day prognosis) admitted to our hospital. Twenty-eight healthy volunteers were recruited as the control group. Blood components at 48 h after burn were analysed for sTLT-1 and biomarkers reflecting platelet activation, shock, endothelial glycocalyx damage, capillary leakage, haemostasis, fibrinolytic activity, natural anticoagulation and blood cells. We compared the three groups, analysed the correlation between sTLT-1 and biomarkers, and investigated the predictive value of sTLT-1 for 30-day prognosis.
Compared with the surviving patients, the patients who died had a lower degree of platelet activation [lower sTLT-1, platelet factor 4 (PF-4) and platelet counts] and a higher degree of burn [higher abbreviated burn severity index score (ABSI score)], shock (higher lactate), endothelial glycocalyx damage [higher syndecan-1 and soluble thrombomodulin (sTM)] and capillary leakage [higher resuscitation fluid (0-48 h), lower albumin] as well as decreased haemostasis [higher activated partial prothrombin time (APTT), lower fibrinogen and thrombin-antithrombin III complex (TAT)], increased fibrinolytic activity [higher D-dimer and tissue-type plasminogen activator (tPA)] and decreased natural anticoagulation [lower protein C (PC) and protein S (PS)]. Higher D-dimer (P = 0.013) and lower PF-4 (P = 0.001) were significantly independently associated with lower sTLT-1. Low circulating sTLT-1 (a unit is 50 pg/mL) (odds ratio [OR] 2.08 [95% CI 1.11-3.92], P = 0.022) was an independent predictor of increased 30-day mortality.
Low sTLT-1 levels at 48 h after burn in patients with severe burns is associated with increased coagulation disorders. Low circulating sTLT-1 levels were an independent predictor of increased 30-day mortality.
严重烧伤患者在早期常出现全身凝血变化，甚至发展为广泛的凝血病。先前的研究证实，可溶性TREM样转录本-1（sTLT-1）在炎症性血管损伤中介导一种新的止血和血栓形成机制。目前，sTLT-1在严重烧伤患者中的作用尚不清楚。
探讨严重烧伤患者sTLT-1水平与烧伤严重程度、凝血障碍、内皮通透性、休克及预后指标之间的早期关联。
对我院收治的60例严重烧伤患者（根据30天预后分为死亡组和存活组）进行前瞻性观察研究。招募28名健康志愿者作为对照组。分析烧伤后48小时血液中的sTLT-1以及反映血小板活化、休克、内皮糖萼损伤、毛细血管渗漏、止血、纤溶活性、天然抗凝和血细胞的生物标志物。我们比较了三组，分析了sTLT-1与生物标志物之间的相关性，并研究了sTLT-1对30天预后的预测价值。
与存活患者相比，死亡患者的血小板活化程度较低（sTLT-1、血小板因子4（PF-4）和血小板计数较低），烧伤程度较高（简化烧伤严重指数评分（ABSI评分）较高）、休克（乳酸水平较高）、内皮糖萼损伤（syndecan-1和可溶性血栓调节蛋白（sTM）较高）和毛细血管渗漏（复苏液（0 - 48小时）较高，白蛋白较低），以及止血功能下降（活化部分凝血活酶时间（APTT）较高，纤维蛋白原和凝血酶 - 抗凝血酶III复合物（TAT）较低）、纤溶活性增加（D - 二聚体和组织型纤溶酶原激活剂（tPA）较高）和天然抗凝功能下降（蛋白C（PC）和蛋白S（PS）较低）。较高的D - 二聚体（P = 0.013）和较低的PF - 4（P = 0.001）与较低的sTLT-1显著独立相关。低循环sTLT-1（单位为50 pg/mL）（比值比[OR] 2.08 [95%置信区间1.11 - 3.92]，P = 0.022）是30天死亡率增加的独立预测因素。
严重烧伤患者烧伤后48小时sTLT-1水平较低与凝血障碍增加有关。低循环sTLT-1水平是30天死亡率增加的独立预测因素。
