Boldt J, Müller M, Heesen M, Papsdorf M, Hempelmann G
Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
Crit Care Med. 1997 Jan;25(1):95-100. doi: 10.1097/00003246-199701000-00019.
Soluble adhesion molecules are regarded to be markers of inflammation, endothelial activation, or damage. The influence of age on plasma concentrations of circulating adhesion molecules should be serially studied in critically ill intensive care patients.
Prospective and descriptive study over 5 days.
Clinical investigation in a surgical intensive care unit of a university hospital.
Thirty critically ill patients (Acute Physiology and Chronic Health Evaluation [APACHE] II score of > 15 points), with sepsis secondary to postoperative complications, were included in this study. Fifteen consecutive patients aged < 50 yrs and 15 consecutive patients aged > 70 yrs were prospectively studied.
All patients were treated by the standard protocols of our intensive care unit, which did not differ between the groups. The patients received continuous analgesia-sedation and mechanical ventilation. Intensivists caring for the patients were not involved in the study and were blinded to data analysis.
Hemodynamic parameters were extensively monitored in all patients. From arterial blood samples, plasma concentrations of soluble adhesion molecules (endothelial leukocyte adhesion molecule-1, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, granule membrane protein-140) were measured on the day of admission (i.e., baseline values) and during the following 5 days. Three of the younger patients and six of the elderly patients died during the study period (p < .05). Oxygen delivery and consumption, and the other hemodynamic data, were without group differences throughout the study. Plasma concentrations of all adhesion molecules were beyond normal at baseline in both groups. These concentrations increased further during the first 2 to 3 days in both groups, with a significantly higher increase in the elderly patients (endothelial leukocyte adhesion molecule-1 to 179 +/- 32 ng/mL; intercellular adhesion molecule-1 to 1695 +/- 158 ng/mL; vascular cell adhesion molecule-1 to 1395 +/- 212 ng/mL; and granule membrane protein-140 to 888 +/- 119 ng/mL). In the younger patients, concentrations of soluble adhesion molecules decreased later in the study and almost reached baseline values on day 5. In the elderly patients, these concentrations remained significantly higher until the end of the study.
The higher plasma concentrations of the measured adhesion molecules in elderly critically ill patients indicate that elderly patients are more prone than younger patients to a more pronounced activation or even damage of the endothelium. Further work needs to be done to determine the prognostic importance and to define the role of soluble adhesion molecules, particularly in the elderly critically ill patient.
可溶性黏附分子被视为炎症、内皮激活或损伤的标志物。对于重症监护病房的危重症患者，应连续研究年龄对循环黏附分子血浆浓度的影响。
为期5天的前瞻性描述性研究。
大学医院外科重症监护病房的临床研究。
本研究纳入了30例危重症患者（急性生理与慢性健康状况评分[APACHE]II>15分），继发于术后并发症的脓毒症患者。前瞻性研究了15例年龄<50岁的连续患者和15例年龄>70岁的连续患者。
所有患者均按照我们重症监护病房的标准方案进行治疗，两组之间无差异。患者接受持续镇痛镇静和机械通气。照顾患者的重症监护医生未参与研究，且对数据分析不知情。
对所有患者广泛监测血流动力学参数。从动脉血样本中，在入院当天（即基线值）及随后5天测量可溶性黏附分子（内皮细胞白细胞黏附分子-1、细胞间黏附分子-1、血管细胞黏附分子-1、颗粒膜蛋白-140）的血浆浓度。在研究期间，3例年轻患者和6例老年患者死亡（p<0.05）。在整个研究过程中，氧输送和消耗以及其他血流动力学数据在两组之间无差异。两组患者基线时所有黏附分子的血浆浓度均高于正常水平。两组患者在最初2至3天内这些浓度进一步升高，老年患者升高更为显著（内皮细胞白细胞黏附分子-1至179±32 ng/mL；细胞间黏附分子-1至1695±158 ng/mL；血管细胞黏附分子-1至1395±212 ng/mL；颗粒膜蛋白-140至888±119 ng/mL）。在年轻患者中，可溶性黏附分子浓度在研究后期下降，在第5天几乎达到基线值。在老年患者中，这些浓度在研究结束时仍显著更高。
老年危重症患者中所测黏附分子的血浆浓度较高，表明老年患者比年轻患者更容易出现更明显的内皮激活甚至损伤。需要进一步开展工作以确定其预后重要性，并明确可溶性黏附分子的作用，尤其是在老年危重症患者中。
