Uhl W, Beger H G, Hoffmann G, Hanisch E, Schild A, Waydhas C, Entholzner E, Müller K, Kellermann W, Vogeser M
Department of Visceral and Transplantation Surgery, University of Berne, Switzerland.
J Am Coll Surg. 1995 Mar;180(3):323-31.
Multiple organ failure (MOF) is becoming the most common cause of death in patients in surgical intensive care units. In this respect, a multicenter study in four different groups of patients in surgical intensive care units was done to evaluate the role of phospholipase A2 (PLA2) in comparison with C-reactive protein (CRP) and polymorphonuclear (PMN) elastase.
A total of 223 patients entered the study: 73 patients with multiple injuries, 46 patients with diffuse peritonitis, 52 patients with sepsis, and 52 patients in a control group who were at a higher risk for postoperative sepsis after defined surgical interventions. The patients underwent a daily monitoring of PLA2, CRP, and PMN elastase for seven days.
Phospholipase A2 activity remained within the normal range in patients with multiple injuries and patients in the control group, indicating that this parameter is not influenced by the postaggression metabolism. In contrast, in patients with peritonitis, high PLA2 values were found from the beginning. The efficiency for predicting a lethal MOF was 85 percent for PLA2 (cut-off 80 U/L) in patients if determined at the day of operation. A comparably favorable efficiency (84 percent) was demonstrated for PMN elastase in patients with multiple injuries (cut-off 205 micrograms/L) measured at day one.
These efficiency rates of PLA2 in peritonitis and PMN elastase in multiple injuries were comparable or even better than multifactorial scoring systems used in the study. C-reactive protein did not contribute to an early estimation of the prognosis in all groups analyzed. Therefore, the measurement of PLA2 in patients with diffuse peritonitis and PMN elastase in patients with multiple injuries, as single parameters, is recommended to estimate the individual risk for the occurrence of lethal MOF.
多器官功能衰竭（MOF）正成为外科重症监护病房患者最常见的死亡原因。在这方面，针对外科重症监护病房中四组不同患者开展了一项多中心研究，以评估磷脂酶A2（PLA2）与C反应蛋白（CRP）及多形核（PMN）弹性蛋白酶相比的作用。
共有223例患者进入研究：73例多发伤患者、46例弥漫性腹膜炎患者、52例脓毒症患者以及52例对照组患者，后者在特定外科手术后发生脓毒症的风险较高。对患者进行了为期7天的PLA2、CRP和PMN弹性蛋白酶每日监测。
多发伤患者及对照组患者的磷脂酶A2活性保持在正常范围内，表明该参数不受侵袭后代谢的影响。相比之下，腹膜炎患者从一开始就发现PLA2值较高。如果在手术当天测定，PLA2（临界值80 U/L）对预测患者致命性MOF的效率为85%。在多发伤患者中，第1天测定的PMN弹性蛋白酶（临界值205微克/L）显示出相当不错的效率（84%）。
PLA2在腹膜炎中的效率以及PMN弹性蛋白酶在多发伤中的效率与研究中使用的多因素评分系统相当，甚至更好。C反应蛋白在所有分析组中对预后的早期评估均无贡献。因此，建议将弥漫性腹膜炎患者的PLA2测定以及多发伤患者的PMN弹性蛋白酶测定作为单一参数，以评估发生致命性MOF的个体风险。
