한국학술정보. Key Words: Trauma, Cytokine, ISS, SIRS
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1 Relationship of Interleukin-4, 6, 10, 12 and Tumor Necrosis Factor-S e r u m Levels to Severity of Injury and Clinical Outcome in Trauma Patients Seok Yong Ryu, M.D., Heon Chul Jin, M.D., Jun Young Noh, M.D., Hong Yong Kim, M.D., Se whan Han, M.D. 1, Ki Whan Kim, M.D. 1, Sung Jun Kim, M.D. 2, Tae Hee Han, M.D. 3 P u r p o s e: Trauma has been recognized to be accompanied by alterations of leukocyte, functions such as cytokine release. The regulatory mechanisms involved in these changes are still poorly defined. The aims of this prospective clinical study are to evaluate serum concentrations of cytokines in trauma patients with high risk of developing multiple organ failure, to investigate early change, and to examine the possible prognostic value of these elements. M e t h o d s: Thirty-two patients with multiple traumatic injuries were studied. Patients were classified by age, sex, vector, Injury Severity Score (ISS), Triage Revised Trauma Score (T-RTS), and Systemic Inflammatory Response Syndrome (SIRS). Patients were categorized into two groups, depending on the severity of injury. Group 1 (n=21) consisted of patients with severe injuries and an ISS equal to or greater than 17 points. Group 2 (n=11) consisted of patients with minor injuries and an ISS less than 17 points. Whole blood and serum were obtained immediately after admission to the emergency department, and on days 1 and 3 after trauma. The post-traumatic serum levels of TNF-, IL-4, IL-6, IL-10, and IL-12 were monitored using an enzyme-linked immunosorbent assay technique (ELISA). R e s u l t s: The 32 severely injured patients had a mean Injury Severity Score of points. SIRS developed in 24 patients. Serum levels of IL-6, IL-10, and TNF- were increased immediately and at 1 day and 3 days after the trauma, but the levels of IL-4 and IL-12 were not changed. Serum levels of IL-4, IL-6, IL-10, IL-12, and TNF- were not related to the severity of the injury. However, the serum level of IL-10 was significantly increased at admission and on day 1 in patients who died (< ). C o n c l u s i o n: Serum IL-6, IL-10, and TNF- levels were affected by injury. However, their levels did not correlate with the degree of injury. The serum level of IL-10 was significantly increased at admission and on day 1 in patients who died. Key Words: Trauma, Cytokine, ISS, SIRS Departments of Emergency Medicine, Surgery 1, Preventive Medicine 2, and Laboratory Medicine 3, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea 415
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10 424 / 07. Malone D, Napolitano LM, Genuit T, Bochicchio GV, Kole K, Scalea TM. Total cytokine immunoassay: a more accurate method of cytokine measurement? J Trauma 2001;50(5): The Abbreviated Injury Scale 1990 Revision, Update 1998, Association for the Advancement of Automative Medicine, Des Plaines, IL. 09. Copes WS, Champion HR, Sacco WJ, Lawnick MN, Keast SL, Bain LW. The injury severity score revised. J Trauma 1988;28: Majetschak M, Flach R, Kreuzfelder E, Jennissen V, Heukamp T, Neudeck F, et al. The extent of traumatic damage determines a graded depression of the endotoxin responsiveness of peripheral blood mononuclear cells from patients with blunt injuries. Crit Care Med 1999;27(2): Giannoudis PV, Smith RM, Banks RE, Windsor AC, Dickson RA, Guillou PJ. Stimulation of inflammatory markers after blunt trauma. Br J Surg 1998;85(7): Majetschak M, Borgermann J, Waydhas C, Obertacke U, Nast-Kolb D, Schade FU. Whole blood tumor necrosis factor-alpha production and its relation to systemic concentrations of interleukin 4, interleukin 10, and transforming growth factor-beta1 in multiply injured blunt trauma victims. Crit Care Med 2000;28(6): Boyd CR, Tolson MA, Copes WS. Evaluating trauma care:the TRISS method. J Trauma 1987;27: Martin C, Boisson C, Haccoun M, Thomachot L, Mege JL. Patterns of cytokine evolution (tumor necrosis factoralpha and interleukin-6) after septic shock, hemorrhagic shock, and severe trauma. Crit Care Med 1997;25 (11): Davies MG, Hagen PO. Systemic inflammatory response syndrome. Br J Surg 1997;84(7): Napolitano LM, Ferrer T, McCarter RJ Jr, Scalea TM. Systemic inflammatory response syndrome score at admission independently predicts mortality and length of stay in trauma patients. Trauma 2000;49(4): Scheingraber S, Bauernfeind F, Dobbert D, Dralle H. Monitoring of interleukin 10, tumour necrosis factor alpha and procalcitonin in addition to conventional parameters in the detection of postoperative complications after major abdominal surgery. Br J Surg 2001;88(8): Mack VE, McCarter MD, Naama HA, Calvano SE, Daly JM. Dominance of T-helper 2-type cytokines after severe injury. Arch Surg 1996;131(12): Wick M, Kollig E, Muhr G, Koller M. The potential pattern of circulating lymphocytes TH1/TH2 is not altered after multiple injuries. Arch Surg 2000;135(11): Wick M, Kollig E, Walz M, Muhr G, Koller M. Does liberation of interleukin-12 correlate with the clinical course of polytraumatized patients? Chirurg 2000;71(9): Lyons A, Goebel A, Mannick JA, Lederer JA. Protective effects of early interleukin 10 antagonism on injuryinduced immune dysfunction. Arch Surg 1999;134 (12): Biffl WL, Moore EE, Moore FA, Peterson VM. Interleukin-6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 1996;224(5): Dellinger RP. Tumor necrosis factor in septic shock and multiple system trauma. Crit Care Med 1997;25(11): Sherry RM, Cue JI, Goddard JK, Parramore JB, DiPiro JT. Interleukin-10 is associated with the development of sepsis in trauma patients. J Trauma 1996;40(4): Neidhardt R, Keel M, Steckholzer U, Safret A, Ungethuem U, Trentz O, et al. Relationship of interleukin- 10 plasma levels to severity of injury and clinical outcome in injured patients. J Trauma 1997;42(5): Pasquale MD, Cipolle MD, Monaco J, Simon N. Early inflammatory response correlates with the severity of injury. Crit Care Med 1996;24(7): Sala G, Canevari C, Galimberti G, Raggi ME, Castelli E, Ferrarese C. Increased interleukin-6 release from peripheral blood cells of patients after brain trauma. J Neurochem 2001;76 Suppl: Borrelli E, Roux-Lombard P, Grau GE, Girardin E, Ricou B, Dayer J, et al. Plasma concentrations of cytokines, their soluble receptors, and antioxidant vitamins can predict the development of multiple organ failure in patients at risk. Crit Care Med 1996;24(3): Hensler T, Sauerland S, Bouillon B, Raum M, Rixen D, Helling HJ, et al. Association between injury pattern of patients with multiple injuries and circulating levels of soluble tumor necrosis factor receptors, interleukin-6 and interleukin-10, and polymorphonuclear neutrophil elastase. J Trauma 2002;52(5): DiPiro JT, Howdieshell TR, Goddard JK, Callaway DB, Hamilton RG, Mansberger AR Jr. Association of interleukin-4 plasma levels with traumatic injury and clinical course. Arch Surg 1995;130(11):
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