中暑相关疾病患者的补体激活：可溶性CD59是一种指示中暑相关疾病严重程度的新型生物标志物。
Complement Activation in Patients With Heat-Related Illnesses: Soluble CD59 Is a Novel Biomarker Indicating Severity of Heat-Related Illnesses.
作者信息
Nakamura Yuki, Sueyoshi Koichiro, Miyoshi Yukari, Ishihara Tadashi, Hirano Yohei, Kondo Yutaka, Kuroda Yoko, Iwabuchi Kazuhisa, Okamoto Ken, Tanaka Hiroshi
机构信息
Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan.
Institute for Environmental and Gender Specific Medicine, Juntendo University, Urayasu, Japan.
出版信息
Crit Care Explor. 2022 Apr 21;4(4):e0678. doi: 10.1097/CCE.0000000000000678. eCollection 2022 Apr.
OBJECTIVES
Although multiple organ dysfunction syndrome (MODS) is the main cause of death in patients with heat-related illnesses, its underlying pathophysiological mechanism remains elusive. Complement activation is considered one of the main causes of MODS in patients with sepsis and trauma. Considering the pathophysiological similarity of heat related-illnesses with sepsis and trauma, the complement system might be activated in patients with heat-related illnesses as well. Our aim was to investigate whether excessive complement activation occurs in patients with heat-related illnesses.
DESIGN
Prospective observational study.
SETTING
Emergency department in the university hospital.
PATIENTS
Thirty-two patients with heat-related illnesses and 15 age-matched healthy controls were enrolled in this study.
INTERVENTIONS
Blood samples were collected from the study subjects for the measurement of complement factors.
MEASUREMENTS AND MAIN RESULTS
Complement component 3a (C3a), complement component 5a (C5a), C5b-9, complement factor B (Ba), Factor H, and soluble CD59 in plasma were measured. The levels of C3a, C5a, C5b-9, and Ba significantly increased in patients with heat-related illnesses on day 0 compared with those in the healthy controls. Soluble CD59 was significantly high in patients with heat-related illnesses on day 0 and showed a correlation with the severity of the condition (Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and staging scores), Japanese Association for Acute Medicine disseminated intravascular coagulation scores, and the coagulation system (prothrombin time and fibrin degradation products).
CONCLUSIONS
The complement system was activated in patients with heat-related illnesses, suggesting that it is one of the causes of MODS. Soluble CD59 may be a potent biomarker for the severity of heat-related illnesses.
目的
尽管多器官功能障碍综合征（MODS）是中暑相关疾病患者死亡的主要原因，但其潜在的病理生理机制仍不清楚。补体激活被认为是脓毒症和创伤患者发生MODS的主要原因之一。鉴于中暑相关疾病与脓毒症和创伤在病理生理上具有相似性，补体系统在中暑相关疾病患者中可能也会被激活。我们的目的是研究中暑相关疾病患者是否发生补体过度激活。
设计
前瞻性观察性研究。
地点
大学医院急诊科。
患者
本研究纳入了32例中暑相关疾病患者和15名年龄匹配的健康对照者。
干预措施
采集研究对象的血样以检测补体因子。
测量指标及主要结果
检测血浆中补体成分3a（C3a）、补体成分5a（C5a）、C5b-9、补体因子B（Ba）、因子H和可溶性CD59。与健康对照者相比，中暑相关疾病患者在第0天的C3a、C5a、C5b-9和Ba水平显著升高。中暑相关疾病患者在第0天的可溶性CD59显著升高，且与病情严重程度（急性生理与慢性健康状况评分II、序贯器官衰竭评估和分期评分）、日本急性医学协会弥散性血管内凝血评分以及凝血系统（凝血酶原时间和纤维蛋白降解产物）相关。
结论
中暑相关疾病患者的补体系统被激活，提示其可能是MODS的病因之一。可溶性CD59可能是中暑相关疾病严重程度的有效生物标志物。
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