Gando S, Nakanishi Y, Kameue T, Nanzaki S
Department of Emergency and Critical Care Medicine, Sapporo City General Hospital, Japan.
J Trauma. 1995 Oct;39(4):660-4. doi: 10.1097/00005373-199510000-00007.
Our goal was to investigate the role of soluble thrombomodulin (TM) and neutrophil elastase in patients with trauma.
This study is a prospective case-control study.
Forty-seven trauma victims, 14 with disseminated intravascular coagulation (DIC), 5 with multiple organ dysfunction syndrome (MODS), and 28 control patients without DIC or MODS were the participants. Soluble TM and neutrophil elastase (elastase-alpha1-proteinase inhibitor complex) were measured on the day of the injury, and on the first, third, and fifth days after admission. The results of these measurements and demographic data were compared among the groups, and correlations between the soluble TM and the neutrophil elastase were examined. The DIC patients were classified into subgroups of survivors (n = 5) and nonsurvivors (n = 9), and the changes of the soluble TM between the subgroups were then studied.
A high incidence of DIC patients encountered MODS complications (12 of 14, 86%). The DIC patients had higher Injury Severity Scores (ISSs) than the other patients. The levels of soluble TM and neutrophil elastase significantly increased on the day of admission in the patients with DIC and also in those with MODS (p < 0.05 vs. control patients) and continued to show markedly high values until the fifth day of admission in the patients with DIC. In the DIC patients, the levels of soluble TM were higher in the nonsurvivors than in the survivors (p < 0.05 on the third and the fifth days of admission). In all patients, there was weak but statistically significant correlation between peak levels of soluble TM and ISS (r2 = 0.125, p < 0.025). Comparison of the levels of soluble TM and neutrophil elastase in the patients with DIC or MODS demonstrated an excellent correlation (r2 = 0.718 and r2 = 0.714, respectively).
Soluble TM as a novel endothelial cell injury marker increases in patients with DIC and also in those with MODS after trauma. Neutrophil elastase may be involved in the pathogenesis of the injury. Soluble TM is a marker of the severity of injury and is a good predictor of MODS.
我们的目标是研究可溶性血栓调节蛋白（TM）和中性粒细胞弹性蛋白酶在创伤患者中的作用。
本研究是一项前瞻性病例对照研究。
47名创伤受害者参与研究，其中14名患有弥散性血管内凝血（DIC），5名患有多器官功能障碍综合征（MODS），28名未患DIC或MODS的患者作为对照。在受伤当天、入院后的第1天、第3天和第5天测量可溶性TM和中性粒细胞弹性蛋白酶（弹性蛋白酶-α1-蛋白酶抑制剂复合物）。比较这些测量结果和人口统计学数据在各组之间的差异，并检查可溶性TM与中性粒细胞弹性蛋白酶之间的相关性。将DIC患者分为存活亚组（n = 5）和非存活亚组（n = 9），然后研究亚组之间可溶性TM的变化。
DIC患者中MODS并发症的发生率很高（14例中有12例，86%）。DIC患者的损伤严重程度评分（ISS）高于其他患者。可溶性TM和中性粒细胞弹性蛋白酶的水平在DIC患者以及MODS患者入院当天显著升高（与对照患者相比，p < 0.05），并且在DIC患者中直到入院第5天仍持续显示出明显的高值。在DIC患者中，非存活者的可溶性TM水平高于存活者（入院第3天和第5天，p < 0.05）。在所有患者中，可溶性TM峰值水平与ISS之间存在弱但具有统计学意义的相关性（r2 = 0.125，p < 0.025）。比较DIC或MODS患者中可溶性TM和中性粒细胞弹性蛋白酶的水平显示出良好的相关性（分别为r2 = 0.718和r2 = 0.714）。
可溶性TM作为一种新型的内皮细胞损伤标志物，在创伤后DIC患者以及MODS患者中升高。中性粒细胞弹性蛋白酶可能参与了损伤的发病机制。可溶性TM是损伤严重程度的标志物，也是MODS的良好预测指标。
