Waydhas C, Nast-Kolb D, Trupka A, Lenk S, Duswald K H, Schweiberer L, Jochum M
Department of Surgery, Klinikum Innenstadt, Ludwig-Maximilians-University of Munich, FRG.
Crit Care Med. 1993 Feb;21(2):240-7. doi: 10.1097/00003246-199302000-00016.
To determine the serum concentrations of procollagen type III peptide in severely injured patients with different outcomes and to evaluate the relationship between serum procollagen type III peptide concentrations, sources of increased posttraumatic fibrotic activity (wounds, lung, liver, kidney), and decreased elimination of procollagen type III peptide (liver).
Prospective study.
Surgical ICU, university hospital.
Fifty-seven patients (mean injury severity score: 38.5 points, range 13 to 75 points), between 16 and 70 yrs of age, treated in our institution within 6 hrs after the accident.
Serial measurements were started on admission and continued on a 6-hr basis. After 48 hrs, the monitoring interval was extended to 24 hrs until recovery (but at least until day 14) or death. At each point of evaluation, pulmonary and circulatory function parameters and chest radiographs (once a day) were evaluated, the results were recorded, and blood samples were drawn to determine procollagen type III peptide, total bilirubin, creatinine, gamma-glutamyl transferase, polymorphonuclear elastase, and other parameters. Statistic evaluation was done with the Wilcoxon test, Spearman rank correlation, and a multiple regression model.
Mean procollagen type III peptide serum concentrations (+/- SD) were significantly different in patients who died (8.0 +/- 3.8 U/mL) compared with those patients who survived with organ failure (2.7 +/- 1.3 U/mL) or without complications (1.4 +/- 0.5 U/mL), respectively. Significant correlations of procollagen type III peptide concentrations with the serum bilirubin concentrations (r = .7), days with need of mechanical ventilation (r = .64), PaO2/FIO2 ratio (r = -.6), polymorphonuclear elastase (r = .6), serum creatinine concentrations (r = .55), and injury severity score (r = .33) were observed. There was a tendency toward higher serum procollagen type III peptide concentrations in patients with severe skeletal injuries.
Serum procollagen type III peptide concentrations in severely injured patients may be considerably increased in correlation with injury severity and outcome. Procollagen type III peptide serum concentrations seem to reflect the sum of increased collagen formation from wound healing and fibrogenesis of mediator-related organ damage (especially lung) and decreased procollagen type III peptide excretion due to impaired liver function. Further data are necessary to evaluate the role of hepatic elimination in these patients.
测定不同转归的重症创伤患者血清Ⅲ型前胶原肽浓度，并评估血清Ⅲ型前胶原肽浓度、创伤后纤维化活动增加的来源（伤口、肺、肝、肾）以及Ⅲ型前胶原肽清除减少（肝脏）之间的关系。
前瞻性研究。
大学医院外科重症监护病房。
57例患者（平均损伤严重度评分：38.5分，范围13至75分），年龄在16至70岁之间，于事故发生后6小时内在本院接受治疗。
入院时开始连续测量，并每6小时进行一次。48小时后，监测间隔延长至24小时，直至康复（但至少至第14天）或死亡。在每个评估点，评估肺和循环功能参数及胸部X光片（每天一次），记录结果，并采集血样以测定Ⅲ型前胶原肽、总胆红素、肌酐、γ-谷氨酰转移酶、多形核弹性蛋白酶及其他参数。采用Wilcoxon检验、Spearman秩相关和多元回归模型进行统计学评估。
死亡患者的平均血清Ⅲ型前胶原肽浓度（±标准差）（8.0±3.8 U/mL）与器官功能衰竭存活患者（2.7±1.3 U/mL）或无并发症患者（1.4±0.5 U/mL）相比有显著差异。观察到Ⅲ型前胶原肽浓度与血清胆红素浓度（r = 0.7）、需要机械通气的天数（r = 0.64）、PaO2/FIO2比值（r = -0.6）、多形核弹性蛋白酶（r = 0.6）、血清肌酐浓度（r = 0.55）及损伤严重度评分（r = 0.33）之间存在显著相关性。严重骨骼损伤患者的血清Ⅲ型前胶原肽浓度有升高趋势。
重症创伤患者血清Ⅲ型前胶原肽浓度可能随损伤严重度和转归显著升高。Ⅲ型前胶原肽血清浓度似乎反映了伤口愈合和介质相关器官损伤（尤其是肺）纤维化形成增加的胶原总量，以及因肝功能受损导致的Ⅲ型前胶原肽排泄减少。需要更多数据来评估肝脏清除在这些患者中的作用。
