Tan L R, Waxman K, Scannell G, Ioli G, Granger G A
Department of Surgery, University of California, Irvine.
J Trauma. 1993 May;34(5):634-8. doi: 10.1097/00005373-199305000-00004.
The importance of tumor necrosis factor (TNF) in the pathophysiology of trauma and hemorrhagic shock is not known. In addition, TNF bioactivity may be modulated by soluble forms of the 55-kd and 75-kd membrane receptors (TNFR). This study was undertaken to determine circulating levels of TNF and TNFR after trauma. Nine severely injured male patients were studied. The mean age was 30 +/- 10 years (range, 15-45). The mean Injury Severity Score (ISS) was 31.3 +/- 17.6 (range, 10-59), and the mean Revised Trauma Score (RTS), 5.7 +/- 2.2 (range, 0.7-7.8). Serum was obtained immediately upon arrival at our trauma center, within 1 hour of injury. The TNF and TNFR levels in the serum were measured using ELISA techniques. After trauma, 55-kd and 75-kd TNFR levels were significantly elevated above those of controls (6.99 +/- 4.57 ng/mL and 5.42 +/- 1.88 ng/mL, respectively, p < 0.01); TNF levels were not increased. Patient serum containing TNFR inhibited in vitro TNF cytotoxicity and correlated with 55-kd TNFR levels (p < 0.05). We conclude that TNF is a strong releasing factor for TNFR; the presence of TNFR may be indirect evidence that TNF is present after trauma, despite low measured levels. Both TNF and TNFR may be more important in trauma and hemorrhagic shock than previously thought.
肿瘤坏死因子（TNF）在创伤和失血性休克病理生理学中的重要性尚不清楚。此外，TNF生物活性可能受55-kd和75-kd膜受体（TNFR）可溶性形式的调节。本研究旨在测定创伤后TNF和TNFR的循环水平。对9例严重受伤的男性患者进行了研究。平均年龄为30±10岁（范围15 - 45岁）。平均损伤严重度评分（ISS）为31.3±17.6（范围10 - 59），平均修正创伤评分（RTS）为5.7±2.2（范围0.7 - 7.8）。患者抵达我们的创伤中心后，在受伤后1小时内立即采集血清。采用ELISA技术测定血清中TNF和TNFR水平。创伤后，55-kd和75-kd TNFR水平显著高于对照组（分别为6.99±4.57 ng/mL和5.42±1.88 ng/mL，p < 0.01）；TNF水平未升高。含有TNFR的患者血清在体外抑制TNF细胞毒性，且与55-kd TNFR水平相关（p < 0.05）。我们得出结论，TNF是TNFR的强效释放因子；尽管测得的TNF水平较低，但TNFR的存在可能间接证明创伤后存在TNF。TNF和TNFR在创伤和失血性休克中可能比以前认为的更重要。
