Egerer K, Rohr U, Krausch D, Kox W
Klinik für Anaesthesiologie und Intensivtherapie, Universitätsklinikum Charité, Humboldt-Universität Berlin.
Anaesthesist. 1997 Jul;46(7):592-8. doi: 10.1007/s001010050442.
The aim of this study was to investigate whether the plasma levels of the circulating adhesion molecules sICAM-1 and sE-selectin could serve as early predictors of developing sepsis and its severity.
Twenty-four patients admitted to an intensive care unit with a high risk of developing septic complications were enrolled in this study. Patients were divided into three groups: group I, with infection without systemic sepsis, n = 8; group II, surviving patients with severe sepsis and multi-organ failure (MOF), n = 8; and group III, nonsurviving patients with severe sepsis and MOF, n = 8. Classification of patients was performed according to the clinical criteria defined by the Sepsis Consensus Conference in 1992. Blood samples were taken at 7 a.m. starting from the day of admission until the 7th day after diagnosis of sepsis. Plasma levels of sICAM-1 and sE-selectin were determined in all samples taken between the 3rd pre-septic day and the 7th day after the diagnosis of sepsis was made.
In group I, both sICAM-1 (354.21 +/- 128.60 ng/ml, 86 samples) and sE-selectin (30.41 +/- 7.20 ng/ml, 86 samples) levels remained within the reference range over the whole period of observation. The sICAM-1 levels of group II (between 550.82 +/- 275.67 ng/ml and 445.08 +/- 243.63 ng/ml) tended to show values above the reference range without being significant. Mean sICAM-1 levels in group II did not differ from those of group I. From the 2nd pre-septic day onwards the sICAM-1 levels of group III increased, but not significantly. Significant differences in sICAM-1 levels between group I and group III were observed, with peaks at the samples of the 2nd preseptic day and after the 3rd day of sepsis, respectively (P < 0.05). The sE-selectin levels in group II were elevated from the 3rd preseptic day onwards, with a peak value on the 2nd day of sepsis (P < 0.05). Afterwards, levels decreased to initial values despite ongoing sepsis. Mean values of sE-selectin levels of group I and II were significantly different with the onset of sepsis (P < 0.05). Plasma levels of sE-selectin in group III were significantly elevated (66.30 +/- 9.00 ng/ml on the 3rd pre-septic day), reaching their maximal values of 106.67 +/- 21.66 ng/ml at the end of the observation period. Significant differences between sE-selectin levels of groups I and III existed from the 3rd pre-septic day onwards, and between group II and III on the 7th and 8th day of sepsis.
Our results show that sICAM-1 is a relatively non-specific indicator for sepsis. In contrast, sE-selectin seems to be a good and early predictor of the beginning of severe sepsis with MOF. Furthermore, sE-selectin levels seem to have a prognostic value for the severity, possible course, and outcome of developing sepsis.
本研究旨在调查循环黏附分子可溶性细胞间黏附分子-1（sICAM-1）和可溶性E-选择素（sE-selectin）的血浆水平是否可作为脓毒症发生及其严重程度的早期预测指标。
本研究纳入了24例入住重症监护病房且发生脓毒症并发症风险较高的患者。患者被分为三组：第一组，有感染但无全身性脓毒症，n = 8；第二组，存活的严重脓毒症合并多器官功能衰竭（MOF）患者，n = 8；第三组，非存活的严重脓毒症合并MOF患者，n = 8。根据1992年脓毒症共识会议定义的临床标准对患者进行分类。从入院当天早上7点开始直至脓毒症诊断后第7天，每天采集血样。在脓毒症诊断前第3天至诊断后第7天采集的所有样本中测定sICAM-1和sE-selectin的血浆水平。
在第一组中，整个观察期内sICAM-1（354.21±128.60 ng/ml，86份样本）和sE-selectin（30.41±7.20 ng/ml，86份样本）水平均保持在参考范围内。第二组的sICAM-1水平（在550.82±275.67 ng/ml至445.08±243.63 ng/ml之间）倾向于高于参考范围，但差异不显著。第二组的平均sICAM-1水平与第一组无差异。从脓毒症诊断前第2天起，第三组的sICAM-1水平升高，但不显著。观察到第一组和第三组的sICAM-1水平存在显著差异，分别在脓毒症诊断前第2天的样本和脓毒症第3天后达到峰值（P < 0.05）。第二组的sE-selectin水平从脓毒症诊断前第3天起升高，在脓毒症第2天达到峰值（P < 0.05）。此后，尽管脓毒症仍在持续，但其水平降至初始值。脓毒症发作时，第一组和第二组的sE-selectin水平平均值有显著差异（P < 0.05）。第三组的sE-selectin血浆水平显著升高（脓毒症诊断前第3天为66.30±9.00 ng/ml），在观察期末达到最大值106.67±21.66 ng/ml。从脓毒症诊断前第3天起，第一组和第三组的sE-selectin水平存在显著差异，在脓毒症第7天和第8天，第二组和第三组也存在显著差异。
我们的结果表明，sICAM-1是脓毒症相对非特异性的指标。相比之下，sE-selectin似乎是严重脓毒症合并MOF发生的良好早期预测指标。此外，sE-selectin水平似乎对脓毒症的严重程度、可能病程及转归具有预后价值。
