Angiopoietin-2, marker and mediator of endothelial activation with prognostic significance early after trauma?
Angiopoietin-2, marker and mediator of endothelial activation with prognostic significance early after trauma?
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DOI：
10.1097/sla.0b013e318162d616
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发表时间：
2008-02-01
影响因子：
9
通讯作者：
Pittet, Jean-Francois
中科院分区：
文献类型：
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作者：
Ganter, Michael T.;Cohen, Mitchell J.;Pittet, Jean-Francois
目的：目的：检测创伤后早期血浆血管生成素-1（Ang-1）、血管生成素-2（Ang-2）和血管内皮生长因子（VEGF）的水平，并探讨其临床意义。Ang-2在脓毒症和急性肺损伤中具有重要的病理意义。鲜为人知的是，血管生成素和VEGF的作用后，早期traumatic.Methods：血液标本从连续的重大创伤患者抵达急诊科后立即获得和血浆样本分析血管紧张素-1，血管紧张素-2，VEGF，内皮细胞活化，蛋白C途径，纤溶系统和补体的标志物。碱缺乏被用作组织灌注不足的量度。前瞻性收集数据。结果：在任何重大液体复苏之前，在受伤后30分钟内从208名成人创伤患者中采集了血液样本。血浆Ang-2水平升高，而Ang-1和VEGF水平未升高，且与损伤严重程度和组织灌注不足独立相关。此外，血浆中的Ang-2水平与内皮细胞活化，凝血功能异常，激活补体级联反应的标志物，并与较差的临床outcome.Conclusions：Ang-2释放创伤后早期的程度成比例的损伤严重程度和全身低灌注。高水平的Ang-2与活化的内皮细胞、凝血异常、补体激活和更差的临床结果相关。这些数据表明，血管紧张素-2是一个标志物，并可能是一个直接介导的内皮细胞活化和功能障碍后，严重创伤。
Objective: To measure plasma levels of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and vascular endothelial growth factor (VEGF) early after trauma and to determine their clinical significance.Background: Angiopoietins and VEGF play a central role in the physiology and pathophysiology of endothelial cells. Ang-2 has recently been shown to have pathogenetic significance in sepsis and acute lung injury. Little is known about the role of angiopoietins and VEGF early after trauma.Methods: Blood specimens from consecutive major trauma patients were obtained immediately upon arrival in the emergency department and plasma samples assayed for Ang-1, Ang-2, VEGF, markers of endothelial activation, protein C pathway, fibrinolytic system, and complement. Base deficit was used as a measure of tissue hypoperfusion. Data were collected prospectively.Results: Blood samples were obtained from 208 adult trauma patients within 30 minutes after injury before any significant fluid resuscitation. Plasma levels of Ang-2, but not Ang-1 and VEGF were increased and correlated independently with severity of injury and tissue hypoperfusion. Furthermore, plasma levels of Ang-2 correlated with markers of endothelial activation, coagulation abnormalities, and activation of the complement cascade and were associated with worse clinical outcome.Conclusions: Ang-2 is released early after trauma with the degree proportional to both injury severity and systemic hypoperfusion. High levels of Ang-2 were associated with an activated endothelium, coagulation abnormalities, complement activation, and worse clinical outcome. These data indicate that Ang-2 is a marker and possibly a direct mediator of endothelial activation and dysfunction after severe trauma.