MECHANISMS OF THE ADULT-RESPIRATORY-DISTRESS-SYNDROME - SELECTINS

被引:8
作者
ALBERT, RK
机构
[1] University of Washington, Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA
关键词
D O I
10.1136/thx.50.Suppl_1.S49
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
The acute lung injury of adult respiratory distress syndrome (ARDS) is characterised by inflammatory cell accumulation and activation in the lung. Selectins are a family of adhesion molecules implicated in leucocyte-endothelial adhesion, whose receptors can exist in a cleaved, soluble form. We investigated whether circulating soluble selectin adhesion molecules, obtained from ARDS at-risk patients, were associated with subsequent ARDS development Eighty two patients, at risk of ARDS, were enrolled from three well-defined groups (multiple trauma, pancreatitis, perforated bowel). Plasma samples were obtained on hospital presentation and soluble L, E, and P selectins were quantified with a sandwich enzyme-linked immunosorbent assay (ELISA). Fourteen patients subsequently developed ARDS. Initial plasma soluble L-selectin (sL-selectin) levels were significantly lower in patients who progressed to ARDS compared to those who did not (p = 0.0001; 95% Cl for mean in ARDS patients as percent of that in non-ARDS patients, 27-61%). Moreover concentrations were lower than in 62 normal volunteers (range 0.37-6.55, median 1.83 μgImL, n = 62), suggesting that a selective reduction of sL-selectin correlates with susceptibility. In addition, a significant correlation was found between low values of sL-selectin and indices of subsequent lung injury including requirement for ventilation (p = 0.0001) and degree of respiratory failure (p=0.0001). A significant correlation was also found between low values of sL-selectin and patient mortality (p = 0.002). These results elucidate the inflammatory cell endothelial interactions in the early stages of ARDS and may be of prognostic value.
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页码:S49 / S52
页数:4
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