Pattern of cytokine (IL-6 and IL-10) level as inflammation and anti-inflammation mediator of multiple organ dysfunction syndrome (MODS) in polytrauma.
Pattern of cytokine (IL-6 and IL-10) level as inflammation and anti-inflammation mediator of multiple organ dysfunction syndrome (MODS) in polytrauma.
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发表时间：
2016-06
影响因子：
0.8
通讯作者：
H. Sapan;I. Paturusi;I. Jusuf;I. Patellongi;M. N. Massi;A. Pusponegoro;S. Arief;Ibrahim Labeda;A. Islam;L. Rendy;M. Hatta
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作者：
H. Sapan;I. Paturusi;I. Jusuf;I. Patellongi;M. N. Massi;A. Pusponegoro;S. Arief;Ibrahim Labeda;A. Islam;L. Rendy;M. Hatta
大面积伤害仍然是全球育龄人群最常见的死亡原因。目前的免疫、炎症模式，基于对复杂宿主反应的功能整合的不完全理解，仍然是发展有效的创新诊断和治疗努力的主要障碍。本研究旨在探讨多发伤后严重损伤状态下炎症和抗炎细胞因子如白细胞介素-6和10（IL-6和IL-10）的表达模式及其相互作用，并以多发伤后多器官功能障碍综合征（MODS）和衰竭（MOF）为主要并发症。这是一项在4个学术1级创伤中心进行的多中心研究，包括54名多发性创伤参与者。入选标准为年龄在16-60岁之间，有新发多发伤急性发作，定义为≥2个身体部位损伤，损伤严重程度评分（ISS）≥16，并且存在全身炎症反应综合征（SIRS）。分别于伤后第2、3、5天检测血清IL-6、IL-10水平。住院期间采用序贯器官功能衰竭评估（SOFA）观察患者MODS或MOF的发生情况，并记录病死率。受试者多为男性，平均年龄35岁，平均9岁，均为交通事故所致多发伤。细胞因子（IL-6、IL-10、IL-6/IL-10比值）的升高与MODS和死亡率成正比。严重创伤的代偿阈值水平为IL-6 50 pg/mL，创伤负荷ISS ≥30。炎症反应高于此阈值水平将导致IL-6、IL-10或IL-6/IL-10比值水平下降，这与不良结局（MODS和死亡）相关。这些细胞因子水平的升高表现为代偿/适应性免疫系统，而其下降则表现为严重创伤后免疫系统的失代偿/衰竭。多发性创伤后IL-6和IL-10的模式代表免疫系统努力恢复体内平衡。除了细胞因子的相互作用外，还必须有其他因素导致严重创伤后的死亡率和不良结局。创伤相关基因组变异或多态性的研究尚需进一步研究。
Massive injury remains the most common cause of death for productive age group globally. The current immune, inflammatory paradigm, based on an incomplete understanding of the functional integration of the complex host response, remains a major impediment to the development of effective innovative diagnostic and therapeutic effort. This study attempt to investigate the pattern of inflammatory and anti-inflammatory cytokines such as interleukin-6 and 10 (IL-6 and IL-10) and their interaction in severe injury condition with its major complication as multiple organ dysfunction syndrome (MODS) and failure (MOF) after polytrauma. This is multicenter study held at 4 academic Level-1 Trauma center included 54 polytrauma participants. Inclusion criteria were age between 16-60 years old, had new acute episode of polytrauma which defined as injury in ≥2 body region with Injury Severity Score (ISS) ≥16, and the presence of Systemic Inflammation Response Syndrome (SIRS). Serum level of IL-6 and IL-10 were taken on day 2, 3, and 5 after trauma. During hospitalization, samples were observed for the occurrence of MODS or MOF using Sequential Organ Failure Assessment (SOFA) and mortality rate were also noted. Participant were mostly male with mean of age of 35, 9 years old, endured polytrauma caused by traffic accident. Elevation of cytokines (IL-6, IL-10, and IL-6/IL-10 ratio) had directly proportional with MODS and mortality. Threshold level of compensation for severe trauma is IL-6 of 50 pg/mL and trauma load of ISS ≥30. Inflammation reaction greater than this threshold level would result in downhill level of IL-6, IL-10, or IL-6/IL-10 ratio which associated with poor outcome (MODS and death). The elevation of these cytokines level were represent as compensation/adaptive immune system and its fall represent decompensating/failure of immune system after severe trauma. The pattern of IL-6 and IL-10 after polytrauma represent immune system effort to restore homeostasis. Besides cytokines interaction, there must be other factors that contribute to mortality and poor outcome after major trauma. Further study is needed to investigate genomic variant or polymorphism related to trauma.