CYTOKINES AND PLASMINOGEN-ACTIVATOR INHIBITOR-1 IN POSTTRAUMA DISSEMINATED INTRAVASCULAR COAGULATION - RELATIONSHIP TO MULTIPLE ORGAN DYSFUNCTION SYNDROME
CYTOKINES AND PLASMINOGEN-ACTIVATOR INHIBITOR-1 IN POSTTRAUMA DISSEMINATED INTRAVASCULAR COAGULATION - RELATIONSHIP TO MULTIPLE ORGAN DYSFUNCTION SYNDROME
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DOI：
10.1097/00003246-199511000-00009
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发表时间：
1995-11-01
影响因子：
8.8
通讯作者：
TEDO, I
中科院分区：
文献类型：
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作者：
GANDO, S;NAKANISHI, Y;TEDO, I
目的：a)探讨肿瘤坏死因子- α (tnf - α)、白细胞介素-1 β (IL-1 β)、纤溶酶原激活物抑制剂-1与弥散性血管内凝血（DIG）的关系；b)确定DIC对死亡率、成人呼吸窘迫综合征（ARDS）和多器官功能障碍综合征的影响；c)找到一个有用的预后指标。设计：前瞻性病例对照研究。环境：城市医院的普通重症监护室（三级护理中心），为150万人提供服务。患者：创伤患者58例；有DIG的22例，无DIG的36例。干预措施:没有。测量方法及主要结果：分别于损伤当天及入院后第1、3、5天测定tnf - α、IL-1 β、纤溶酶原激活物抑制剂-1活性、纤溶酶原激活物抑制剂-1抗原浓度。根据DIG的发生，比较这些测量结果、人口统计数据、疾病严重程度评分、重症监护病房死亡率以及ARDS、多器官功能障碍综合征和脓毒症的发生频率。将DIC患者分为幸存者和非幸存者亚组，研究各组间纤溶酶原激活物抑制剂-1的变化。DIC患者的急性生理和慢性健康评估II评分、损伤严重程度评分、ARDS和多器官功能障碍综合征发生频率均高于DIC患者。DIC患者的死亡率高于非dig患者（59.0% vs 13.8%, p = 0.0009）。DIC患者的tnf - α和IL-1 β浓度高于非dig患者。DIC患者的纤溶酶原激活物抑制剂-1活性和纤溶酶原激活物抑制剂-1抗原浓度，特别是非幸存者的这些值，在入院第5天继续显着升高。在所有创伤患者和DIC患者中，纤溶酶原激活物抑制剂-1对预测死亡的最有利预后价值分别在第3天和第5天确定。两种细胞因子与纤溶酶原激活物抑制剂-1之间无显著相关性。结论：在创伤患者中，DIC是ARDS、多器官功能障碍综合征和死亡的预测因子。TNF-a和IL-1 β可能是DIG的病因之一，而纤溶酶原激活物抑制剂-1可能是ARDS和多器官功能障碍综合征的加重因素之一。纤溶酶原激活物抑制剂-1是创伤后DIG患者死亡的良好预测因子。
Objectives: a) To investigate the relationships between tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), plasminogen activator inhibitor-1, and disseminated intravascular coagulation (DIG); b) to determine the influence of DIC on the mortality rate, adult respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome; and c) to find a useful prognostic index for outcome.Design: Prospective, case-control study.Setting: General intensive care unit (tertiary care center) in a city hospital serving a population of 1.5 million people.Patients: Fifty-eight trauma patients; 22 of the patients with DIG and 36 of the patients without DIG.Interventions: None.Measurements and main Results: TNF-alpha, IL-1 beta, plasminogen activator inhibitor-1 activity, and plasminogen activator inhibitor-1 antigen concentration were measured on the day of the injury, and on days 1, 3, and 5 after admission. The results of these measurements, demographic data, severity of illness score, mortality rate in the intensive care unit and frequencies of ARDS, multiple organ dysfunction syndrome, and sepsis were compared according to the occurrence of DIG. DIC patients were classified into subgroups of survivors and nonsurvivors, and the changes in plasminogen activator inhibitor-1 between subgroups were studied. The Acute Physiology and Chronic Health Evaluation II scores, the Injury Severity Scores, and the frequency of ARDS and multiple organ dysfunction syndrome were higher in the DIC patients. The mortality rate of the DIC patients was higher than the rate of the non-DIG patients (59.0% vs. 13.8%; p = .0009). TNF-alpha and IL-1 beta concentrations increased more in the DIC patients than in the non-DIG patients. Plasminogen activator inhibitor-1 activity and plasminogen activator inhibitor-1 antigen concentrations in the DIC patients, especially those values in the nonsurvivors, continued to be markedly high up to day 5 of admission. The most favorable prognostic value of plasminogen activator inhibitor-1 for the prediction of death in all of the trauma patients and the DIC patients was determined on days 3 and 5, respectively. No significant correlation was noted between the two cytokines and plasminogen activator inhibitor-1.Conclusions: In the patients with trauma, DIC is a predictor of ARDS, multiple organ dysfunction syndrome,and death. TNF-a and IL-1 beta might be one of the causes of DIG, while plasminogen activator inhibitor-1 may be one of the aggravating factors of ARDS and multiple organ dysfunction syndrome. Plasminogen activator inhibitor-1 is a good predictor of death for posttrauma DIG patients.