Serum lipopolysaccharide-binding protein concentrations in trauma victims.
Serum lipopolysaccharide-binding protein concentrations in trauma victims.
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DOI：
10.1089/sur.2006.7.251
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发表时间：
2006-06-01
影响因子：
2
通讯作者：
Napolitano, Lena M
中科院分区：
文献类型：
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作者：
Cunningham, Steven C;Malone, Debra L;Napolitano, Lena M
背景：在低浓度下，脂多糖结合蛋白（LBP），一种识别脂多糖（LPS）的急性期蛋白，催化其转移到由CD14和toll样受体-4组成的细胞受体。先前的研究表明，脓毒症、全身炎症反应综合征（SIRS）或急性胰腺炎患者和体外循环术后血清LBP浓度升高。以前没有研究检查过创伤受害者的LBP表达。我们假设入院时LBP血浆浓度可预测创伤的预后（死亡率）。本研究评估了创伤患者损伤后不久血清LBP浓度的时间依赖性变化。方法：一项前瞻性、单机构、观察性队列研究，纳入121例需要住院治疗的中度至重度创伤成人患者（年龄50岁或17岁）。其中男性占79.6%，平均年龄43.0±20.6岁。平均损伤严重程度评分（ISS）为23 +/- 12，前24小时给予的晶体复苏体积平均为6,640 +/- 3,729 mL。入院时获得知情同意，并在入院时和入院后24小时采集血样。前瞻性数据包括每日SIRS评分、多器官功能障碍评分（MODS）、顺序器官衰竭评估（SOFA）评分、并发症和结局。采用酶联免疫吸附法测定血浆LBP浓度。结果：60例患者（占研究队列的48.8%）需要紧急手术干预，术中大量失血（平均1,404 +/- 2,757 mL）。住院死亡率为16.3%（20例）。重症监护病房平均住院时间8.9±16.4天，住院时间14.8±19.6天。患者入院时血清LBP浓度（平均28.0 +/- 25.3 mg/L，范围2-100 mg/L）明显高于对照组（平均6.2 +/- 2.1 mg/L，范围1.3-12.8 mg/L, p < 0.01），与先前报道的脓毒症患者血浆浓度相似。24 h LBP浓度显著升高（平均72.3 +/- 45.7 mg/L，范围8-210 mg/L， p < 0.05）。入院时，非幸存者的LBP浓度明显高于幸存者。然而，在控制年龄和ISS后，入院时LBP浓度不能预测死亡。
BACKGROUND: In low concentrations, lipopolysaccharide-binding protein (LBP), an acute-phase protein recognizing lipopolysaccharide (LPS), catalyzes its transfer to the cellular receptor consisting of CD14 and Toll-like receptor-4. Previous studies have documented increased serum LBP concentrations in patients with sepsis, systemic inflammatory response syndrome (SIRS), or acute pancreatitis and after cardiopulmonary bypass. No prior studies have examined LBP expression in trauma victims. We hypothesized that admission LBP plasma concentrations are predictive of outcome (mortality) in trauma. This study assessed time-dependent changes in serum LBP concentrations in trauma patients soon after injury.METHODS: A prospective, single-institution, observational cohort study of 121 adult trauma patients (age > or =17 years) with moderate to severe injury who required hospitalization. The trauma patients were male in 79.6% of the cases and had a mean age of 43.0 +/- 20.6 years. The mean injury severity score (ISS) was 23 +/- 12, and the crystalloid resuscitation volume given in the first 24 h averaged 6,640 +/- 3,729 mL. Informed consent was obtained on admission, and blood samples were drawn on admission and at 24 h postadmission. Prospective data were collected for daily SIRS score, multiple organ dysfunction score (MODS), and sequential organ failure assessment (SOFA) score, complications, and outcomes. Plasma concentrations of LBP were measured by enzyme-linked immunosorbent assay.RESULTS: Sixty patients (48.8% of the study cohort) required emergency surgical intervention and sustained a substantial intraoperative blood loss (mean 1,404 +/- 2,757 mL). The hospital mortality rate was 16.3% (20 patients). The mean intensive care unit stay was 8.9 +/- 16.4 days, and the hospital stay was 14.8 +/- 19.6 days. The patients had a significantly higher serum concentrations of LBP on admission (mean 28.0 +/- 25.3 mg/L; range 2-100 mg/L) than did control subjects (mean 6.2 +/- 2.1 mg/L; range 1.3-12.8 mg/L; p < 0.01), similar to the plasma concentrations previously reported in septic patients. A significant increase in LBP concentration was noted at 24 h (mean 72.3 +/- 45.7 mg/L; range 8-210 mg/L; p < 0.05). The admission LBP concentration was significantly greater in nonsurvivors than in survivors. However, after controlling for age and ISS, the admission LBP concentration did not predict death.