Tumor necrosis factor activity increases in the early response to trauma
Tumor necrosis factor activity increases in the early response to trauma
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DOI：
10.1111/j.1553-2712.1997.tb03676.x
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发表时间：
1997-11-01
影响因子：
4.4
通讯作者：
Dechert, R
中科院分区：
文献类型：
--
作者：
Ferguson, KL;Taheri, P;Dechert, R
目的：1) 确定肿瘤坏死因子 (TNF) 上调是否发生在严重损伤后的最初几个小时内，2) 确定从受伤到采血的时间是否影响检测 TNF 的概率。 方法：使用在大学医院 ED（一级创伤中心）治疗的成年重大创伤患者（“患者”）和 20 名健康人的方便样本进行前瞻性横断面研究。 志愿者（“对照”）。测量了从受伤到采集标本的时间间隔 (Delta T)、损伤严重程度量表 (ISS) 评分、患者人口统计数据和定量细胞因子 [TNF 和白细胞介素 (IL-6、IL-8)] 水平。在患者中，细胞因子水平作为 Delta T 的函数进行分析（首先使用每小时截止点，然后使用中位 T 作为任意截止点），有或没有潜在的混杂因素（例如 ISS、年龄、性别）。结果：平均 Delta T 为 92.8 +/- 49.2 分钟（范围 10-210 分钟，中位 82 分钟）。在对照组中，TNF 活性占 96%，平均水平为 125 pg/mL。对照组没有显示基线 IL-6 活性，只有 10% 具有可测量的基线 IL-8 水平。在患者中，93% 的患者存在 TNF，平均水平为 628 +/- 138 pg/mL。当将患者的标本按中位数划分以获得大小大致相等的组时，早期组与晚期组的 TNF 水平比对照升高 >2.5 个标准差（51% vs 30%；p = 0.07）。早期组与晚期组的 TNF 和 IL-8 平均水平也较高（分别为 756 vs 530 和 287 vs 135；p < 0.05）。结论：TNF 水平在受伤后 4 小时内升高。之前的研究人员无法检测到 TNF 活性的增加可能与采样延迟有关。这些结果与以下理论一致：重大创伤后早期TNF活性增加，并可能启动随后的细胞因子活性。
Objectives: 1) To determine whether tumor necrosis factor (TNF) up-regulation occurs in the first hours following severe injury, 2) To determine whether the time from injury to blood sampling affects the probability of detecting TNF.Methods: A prospective, cross-sectional study was performed using a convenience sample of adult major trauma patients (''patients'') treated at a university hospital ED (Level-1 trauma center) and 20 healthy volunteers (''controls''). The time interval from injury to specimen collection (Delta T), the injury severity scale (ISS) score, patient demographics, and quantitative cytokine [TNF and interleukin (IL-6, IL-8)] levels were measured. In the patients, cytokine levels were analyzed as a function of Delta T (using first hourly cutoff points and then the median T as an arbitrary cutoff point) with and without potential confounders (e.g., ISS, age, gender),Results: The mean Delta T was 92.8 +/- 49.2 min (range 10-210 min, median 82 min). In the controls, TNF activity was present in 96%, with a mean level of 125 pg/mL. The controls showed no baseline IL-6 activity and only 10% had a measurable baseline IL-8 level. In the patients, TNF was present in 93%, with a mean level of 628 +/- 138 pg/mL, When the patients' specimens were divided at the median to obtain roughly equal sized groups, more TNF levels were elevated >2.5 SD above the controls in the early vs late group (51% vs 30%; p = 0.07). The mean levels of TNF and IL-8 also were higher in the early vs late group (756 vs 530 and 287 vs 135, respectively; p < 0.05).Conclusions: TNF levels are elevated in the immediate 4 hours post-injury. Previous investigators' inability to detect TNF activity increases may be related to delays in sampling. These results are consistent with the theory that increased TNF activity occurs early after major trauma and may initiate subsequent cytokine activity.