Müller J C, Bührer C, Kiening K L, Kerner T, Gerlach H, Obladen M, Unterberg A W, Lanksch W R
Department of Neurosurgery, Charité/Virchow Medical Center, Humboldt University, Berlin, Germany.
J Trauma. 1998 Oct;45(4):705-8. doi: 10.1097/00005373-199810000-00013.
Binding of the leukocyte glycoprotein L-selectin to ligands expressed by activated endothelium directs leukocyte recruitment to areas of acute inflammation. Sequestration by activated microvascular endothelium has been proposed to explain the low plasma concentrations of soluble L-selectin (sCD62L) observed early in patients with acute respiratory distress syndrome. We hypothesized that inflammatory endothelial activation may occur in trauma patients, leading to decreased sCD62L plasma concentrations.
This study was a prospective analysis of sCD62L plasma concentrations in patients with isolated head injuries and multiple trauma patients without head injuries admitted to two tertiary-level intensive care units. sCD62L plasma concentrations were determined in 18 consecutive adult patients with isolated moderate and severe head injuries and in 13 multiple trauma patients without head injuries immediately upon admission to the intensive care unit and then daily for up to 10 days after trauma.
Compared with healthy adult controls (n=22), patient sCD62L plasma concentrations were significantly decreased upon admission (5.7+/-1.6 vs. 11.0+/-1.7 pmol/mL; p < 0.001). In all patients, sCD62L concentrations remained depressed throughout the study period. sCD62L concentrations did not differ significantly between patients with isolated head injuries and multiple trauma patients without head injuries, although repeated-measures analysis of variance showed significantly more depressed sCD62L concentrations associated with severe (n=14) compared with moderate head injuries (n=4) during the study period (p < 0.05).
Patients with major trauma present with a significant reduction of sCD62L plasma concentrations within the first 12 hours after trauma and during subsequent intensive care. This finding suggests widespread microvascular endothelial activation after trauma, which may be associated with increased neutrophil extravasation.
白细胞糖蛋白L-选择素与活化内皮细胞表达的配体结合，可引导白细胞募集至急性炎症区域。有观点认为，活化的微血管内皮细胞对L-选择素的隔离可解释急性呼吸窘迫综合征患者早期出现的可溶性L-选择素（sCD62L）血浆浓度降低的现象。我们推测创伤患者可能发生炎症性内皮细胞活化，导致sCD62L血浆浓度降低。
本研究对入住两家三级重症监护病房的单纯颅脑损伤患者和无颅脑损伤的多发伤患者的sCD62L血浆浓度进行了前瞻性分析。在18例连续入住的成年单纯中度和重度颅脑损伤患者以及13例无颅脑损伤的多发伤患者入住重症监护病房后即刻测定sCD62L血浆浓度，随后在创伤后长达10天的时间里每天测定一次。
与健康成年对照组（n = 22）相比，患者入院时sCD62L血浆浓度显著降低（5.7±（加号或减号）1.6对11.0±1.7 pmol/mL；p < 0.001）。在所有患者中，整个研究期间sCD62L浓度均持续降低。单纯颅脑损伤患者和无颅脑损伤的多发伤患者之间的sCD62L浓度无显著差异，尽管重复测量方差分析显示，在研究期间，与中度颅脑损伤（n = 4）相比，重度颅脑损伤（n = 14）患者的sCD62L浓度降低更为显著（p < 0.05）。
严重创伤患者在创伤后最初12小时内及随后的重症监护期间，sCD62L血浆浓度显著降低。这一发现提示创伤后存在广泛的微血管内皮细胞活化，这可能与中性粒细胞渗出增加有关。
