Iba T, Yagi Y, Kidokoro A, Fukunaga M, Fukunaga T
Department of Surgery, Juntendo Urayasu Hospital, Juntendo University School of Medicine, Chiba, Japan.
Surg Today. 1995;25(7):585-90. doi: 10.1007/BF00311430.
The fact that thrombomodulin (TM) is released into the bloodstream from damaged vascular endothelial cells led us to hypothesize that plasma levels of soluble TM could be an indicator of the development of organ failure. In this study, we examined the changes in plasma levels of TM in 60 septic patients and 13 postsurgical patients, and investigated the circulating levels of interleukin 6 (IL-6) and polymorphonuclear leukocyte elastase (PMN-E) to determine the mechanism causing the excess liberation of TM. The arterial ketone body ratio (AKBR) was also measured as an indicator of the hepatocyte energy state. Of the 60 septic patients, 26 developed organ failure, 10 of whom died. In contrast, none of the postsurgical patients developed organ failure. The mean plasma level of TM was significantly higher in the septic patients who developed organ failure compared to those without organ failure (P < 0.001) or the postsurgical patients (P < 0.001). Furthermore, those patients whose plasma TM values became elevated over 6.0 ng/ml frequently developed complications. A positive correlation was also observed between the plasma TM levels and the IL-6 (P < 0.01) and PMN-E levels (P < 0.01). In contrast, a negative correlation was seen between the plasma TM levels and the AKBR (P < 0.01). These findings show that plasma TM could be a useful indicator of impending organ failure during sepsis.
血栓调节蛋白（TM）可从受损的血管内皮细胞释放到血液中，这一事实使我们推测，可溶性TM的血浆水平可能是器官衰竭发生的一个指标。在本研究中，我们检测了60例脓毒症患者和13例术后患者血浆TM水平的变化，并研究了白细胞介素6（IL-6）和多形核白细胞弹性蛋白酶（PMN-E）的循环水平，以确定导致TM过度释放的机制。还测量了动脉酮体比率（AKBR）作为肝细胞能量状态的指标。60例脓毒症患者中，26例发生器官衰竭，其中10例死亡。相比之下，术后患者均未发生器官衰竭。发生器官衰竭的脓毒症患者的血浆TM平均水平显著高于未发生器官衰竭的患者（P<0.001）或术后患者（P<0.001）。此外，血浆TM值升高超过6.0 ng/ml的患者经常发生并发症。血浆TM水平与IL-6（P<0.01）和PMN-E水平（P<0.01）之间也观察到正相关。相反，血浆TM水平与AKBR之间呈负相关（P<0.01）。这些发现表明，血浆TM可能是脓毒症期间即将发生器官衰竭的一个有用指标。
