Saba T M, Blumenstock F A, Shah D M, Kaplan J E, Cho E, Scovill W, Stratton H, Newell J, Gottlieb M, Sedransk N
Ann Surg. 1984 Jan;199(1):87-96. doi: 10.1097/00000658-198401000-00015.
Plasma fibronectin is an opsonic glycoprotein which augments reticuloendothelial phagocytic clearance of nonbacterial particulates. We evaluated the influence of intravenous infusion of plasma cryoprecipitate on circulating immunoreactive fibronectin and associated opsonic activity at 0.5, 2.0, 4.0, 10, and 21 hr postinfusion in septic (n = 8) and nonseptic (n = 6) surgical and/or trauma patients with documented plasma fibronectin deficiency. The study was a randomized, double-blind, crossover clinical protocol in which fibronectin-poor (0.116 +/- 0.025 mg/ml) cryoprecipitate extracted plasma (placebo) was compared to fibronectin-rich (2.139 +/- 0.161 mg/ml) plasma cryoprecipitate. Septic injured patients (149.37 +/- 17.11 micrograms/ml) had lower (p less than 0.05) plasma fibronectin levels than nonseptic injured patients (212.17 +/- 7.14 micrograms/ml) and both were less (p less than 0.05) than normal (330 +/- 30 micrograms/ml). As tested in vitro with a peritoneal macrophage monolayer assay, cryoprecipitate manifested opsonic activity related to its fibronectin concentration. Intravenous infusion of fibronectin rich cryoprecipitate reversed both the immunoreactive fibronectin and opsonic deficiency, while infusion of the placebo at a comparable total protein load did not reverse either deficient parameter. Reversal of fibronectin deficiency was more sustained in nonseptic injured patients as compared to septic injured patients. Thus, reversal of opsonic deficiency in septic and nonseptic injured patients is observed after infusion of plasma cryoprecipitate and not with infusion of fibronectin deficient plasma at comparable protein loads. Also, cryoprecipitate extracted plasma may serve as an appropriate control solution for randomized studies evaluating the therapeutic value of fibronectin-rich plasma cryoprecipitate.
血浆纤维连接蛋白是一种调理素糖蛋白，可增强网状内皮系统对非细菌性颗粒的吞噬清除作用。我们评估了在有血浆纤维连接蛋白缺乏记录的脓毒症（n = 8）和非脓毒症（n = 6）手术和/或创伤患者中，静脉输注血浆冷沉淀对输注后0.5、2.0、4.0、10和21小时循环免疫反应性纤维连接蛋白及相关调理活性的影响。该研究是一项随机、双盲、交叉临床方案，其中将纤维连接蛋白含量低（0.116±0.025 mg/ml）的冷沉淀提取血浆（安慰剂）与纤维连接蛋白含量高（2.139±0.161 mg/ml）的血浆冷沉淀进行比较。脓毒症损伤患者（149.37±17.11微克/毫升）的血浆纤维连接蛋白水平低于（p＜0.05）非脓毒症损伤患者（212.17±7.14微克/毫升），且两者均低于（p＜0.05）正常水平（330±30微克/毫升）。在用腹膜巨噬细胞单层试验进行的体外测试中，冷沉淀表现出与其纤维连接蛋白浓度相关的调理活性。静脉输注富含纤维连接蛋白的冷沉淀可逆转免疫反应性纤维连接蛋白和调理素缺乏，而在总蛋白负荷相当的情况下输注安慰剂则不能逆转任何一项缺乏参数。与脓毒症损伤患者相比，非脓毒症损伤患者纤维连接蛋白缺乏的逆转更持久。因此，在输注血浆冷沉淀后，脓毒症和非脓毒症损伤患者的调理素缺乏得到逆转，而在相当蛋白负荷下输注纤维连接蛋白缺乏的血浆则不能。此外，冷沉淀提取血浆可作为评估富含纤维连接蛋白的血浆冷沉淀治疗价值的随机研究的合适对照溶液。
