Plasma Fibronectin and Associated Variables in Surgical Intensive Care Patients
Plasma Fibronectin and Associated Variables in Surgical Intensive Care Patients
复制标题
外科重症监护患者的血浆纤连蛋白和相关变量
作者：
E. Rubli;S. Büssard;E. Frei;P. Lundsgaard;E. Pappová
在危重症、外科手术或创伤患者中观察到血浆纤维连接蛋白或FN的急性耗竭，但FN水平与此类病例的最终结果之间的关系以及其他血清蛋白的同步行为的信息很少。对98例重大择期手术或外伤后重症监护患者进行FN、抗凝血酶III、IgG、C3、白蛋白前蛋白和转铁蛋白的每日监测。根据患者的临床病程，回顾性分为三组。A组有脓毒症33例。B组（31例）无脓毒症并发症，C组（34例）无并发症。脓毒症A组患者的FN、AT III、前白蛋白和转铁蛋白最低水平低于B和c组（p < 0.01）。在脓毒症组中，14例非存活患者的AT III最低水平低于19例存活患者（p < 0.01），但FN最低水平未低于B和c组。在存活超过两周的6例败血症最终死亡病例中，FN和AT III水平至少暂时恢复到正常范围。脓毒症组转铁蛋白实际亚正常比例最高，与FN差异有p < 0.05。此外，6种蛋白总体上呈显著的平行变异模式（p < 0.01）。该结果证实了其他关于脓毒症患者中纤维连接蛋白作为一个群体的行为的报道，但它不能提供个体结果的信息，其减少可能被视为与急性脓毒症相关的一般血浆蛋白消耗的一部分。这种模式可能归因于血管内消耗和蛋白质分解代谢超过合成的综合过量。
An acute depletion of plasma fibronectin or FN has been observed in critically ill, surgical, or trauma patients, but there is little information on the relationships between FN levels and the final outcome in such cases, and on the simultaneous behaviour of other serum proteins. The daily values of FN, antithrombin III, IgG, C3, prealbumin, and transferrin were monitored in 98 intensive care patients after major elective surgery or trauma. According to their clinical course, they were divided retrospectively into three groups. Group A (33 patients) had sepsis. Group B (31 patients) had nonseptic complications, and group C (34 patients) had no complications in the ICU. The individual, nadir levels of FN, AT III, prealbumin, and transferrin were lower (p < 0.01) in the septic group A than in B and C. Within the septic group, the nadir levels of AT III, but not those of FN, were lower (p < 0.01) in the 14 nonsurvivors than in the 19 survivors. The FN and AT III levels had returned at least temporarily to the normal range in the six ultimate fatalities from sepsis who survived for more than two weeks. In the septic group, transferrin showed the highest percentages of actually subnormal levels and differed from FN in this respect with p < 0.05. Furthermore, all six proteins showed a significant overall pattern (p < 0.01) of parallel variations. The results confirm other reports on the behavior of fibronectin in septic patients as a group, but it was not informative as to the individual outcome, and its reduction might be viewed as part of a general plasma protein depletion associated with acute septic disease. This pattern is probably attributable to a combination of intravascular consumption and an overall excess of protein catabolism over synthesis.