Doran J E, Lundsgaard-Hansen P, Rubli E
Intensive Care Med. 1986;12(5):340-9. doi: 10.1007/BF00292924.
Plasma fibronectin has been postulated to be an essential mediator of normal reticuloendothelial system (RES) function. The acute depletion of fibronectin is thought to impair RES function, whereas its repletion in states of deficiency has been reported to improve RES function. In vitro studies have documented fibronectin's ability to bind to some nonbacterial microaggregates and to promote the phagocytosis of bound targets by the RES. These properties may, however, be influenced by the in vivo milieu. There is substantial evidence for a parallelism between RES function and plasma fibronectin levels following blunt trauma in animal models; however, this association is not seen in experimentally induced intravascular coagulation, acute inflammation, and sepsis. Clinically, subnormal fibronectin levels are clearly associated with the triad of intravascular coagulation, organ failure and sepsis. Fibronectin is, however, not the only plasma protein reduced in these patients, nor is it an outstanding predictor of such complications. The therapeutic efficacy of fibronectin administration remains controversial. Whereas initial reports suggested therapeutic benefits of fibronectin-enriched cryoprecipitates, subsequent studies have produced negative results. Prospective, randomized, controlled clinical trials with purified fibronectin are needed before fibronectin should be recommended as an adjunct to the established principles of intensive care.
血浆纤连蛋白被认为是正常网状内皮系统（RES）功能的重要介质。纤连蛋白的急性消耗被认为会损害RES功能，而在缺乏状态下补充纤连蛋白据报道可改善RES功能。体外研究已证明纤连蛋白能够结合一些非细菌性微聚集体，并促进RES对结合靶标的吞噬作用。然而，这些特性可能会受到体内环境的影响。在动物模型中，有大量证据表明钝性创伤后RES功能与血浆纤连蛋白水平之间存在平行关系；然而，在实验性诱导的血管内凝血、急性炎症和脓毒症中未观察到这种关联。临床上，纤连蛋白水平低于正常明显与血管内凝血、器官衰竭和脓毒症三联征相关。然而，纤连蛋白并不是这些患者中唯一减少的血浆蛋白，也不是此类并发症的突出预测指标。纤连蛋白给药的治疗效果仍存在争议。尽管最初的报告表明富含纤连蛋白的冷沉淀有治疗益处，但随后的研究产生了阴性结果。在推荐纤连蛋白作为重症监护既定原则的辅助手段之前，需要进行使用纯化纤连蛋白的前瞻性、随机、对照临床试验。
