Yao Y M, Yu Y, Wang Y P, Tian H M, Sheng Z Y
Trauma Center, Postgraduate Medical College, Beijing, China.
Eur J Clin Invest. 1996 Mar;26(3):224-30. doi: 10.1046/j.1365-2362.1996.128257.x.
The present study was conducted to determine the relationship between levels of neopterin and endotoxin in the circulation, and whether the neopterin level was related to the development of severe sepsis after extensive burns. This prospective study included 35 patients with burn size greater than 30% (30-98%), and 22 healthy volunteers who served as a comparison group. Neopterin levels increased in most patients on day 3 post-burn, but they were not significantly correlated with the extent of the burn surface (P > 0 center dot 05). A high serum neopterin level was found in patients with sepsis (n = 15), and a marked elevation persisted throughout the observation period. The difference between septic and non-septic patients (n = 20) became significant on 14 and 28 days post-burn. Although the presence of early endotoxaemia did not influence the alterations in serum neopterin, patients with endotoxaemia had much higher neopterin values than those who showed no endotoxaemia from the second week onward (P < 0 center dot 05-0 center dot 01). In addition, circulating endotoxin and neopterin levels were positively correlated in patients who developed endotoxaemia on day 14 (r = 0 center dot 368, P < 0 center dot 05) and day 21 (r = 0 center dot 439, P < 0 center dot 01) after major burns. These results suggest that thermal injury can lead to an elevation of serum neopterin independent of the burn surface area. The initial increase in the neopterin level may be a part of the acute-phase response to tissue injury itself, whereas the endotoxin release in the circulation may be responsible for the continuous induction of neopterin during the late stage. In addition, the presence of a constant high neopterin level is associated with a critical event in the development of severe burn sepsis.
本研究旨在确定循环中蝶呤和内毒素水平之间的关系，以及蝶呤水平是否与大面积烧伤后严重脓毒症的发生发展有关。这项前瞻性研究纳入了35例烧伤面积大于30%（30%-98%）的患者，以及22名健康志愿者作为对照组。大多数患者在烧伤后第3天蝶呤水平升高，但与烧伤创面面积无显著相关性（P>0.05）。脓毒症患者（n=15）血清蝶呤水平较高，且在整个观察期内持续显著升高。烧伤后第14天和28天，脓毒症患者（n=15）与非脓毒症患者（n=20）之间的差异变得显著。虽然早期内毒素血症的存在并未影响血清蝶呤的变化，但从第二周起，内毒素血症患者的蝶呤值远高于无内毒素血症患者（P<0.05-0.01）。此外，在大面积烧伤后第14天（r=0.368，P<0.05）和第21天（r=0.439，P<0.01）发生内毒素血症的患者中，循环内毒素和蝶呤水平呈正相关。这些结果表明，热损伤可导致血清蝶呤升高，且与烧伤创面面积无关。蝶呤水平的初始升高可能是对组织损伤本身急性期反应的一部分，而循环中内毒素的释放可能是后期蝶呤持续诱导的原因。此外，持续的高蝶呤水平与严重烧伤脓毒症发展中的关键事件相关。
