PDF(Pubmed)
Abstract：
BACKGROUND: Managing polytrauma victims poses a significant challenge to clinicians since applying the same therapy to patients with similar injury patterns may result in different outcomes. Using serum biomarkers hopefully allows for treating each multiple injured in the best possible individual way. Since matrix metalloproteinases (MMPs) play pivotal roles in various physiological processes, they might be a reliable tool in polytrauma care.
METHODS: We evaluated 24 blunt polytrauma survivors and 12 fatalities (mean age, 44.2 years, mean ISS, 45) who were directly admitted to our Level I trauma center and stayed at the intensive care unit for at least one night. We determined their MMP3, MMP8, MMP9, MMP10, MMP12, and MMP13 serum levels at admission (day 0) and on days 1, 3, 5, 7, and 10.
RESULTS: Median MMP8, MMP9, and MMP12 levels immediately rose after the polytrauma occurred; however, they significantly decreased from admission to day 1 and significantly increased from day 1 to day 10, showing similar time trajectories and (very) strong correlations between each two of the three enzyme levels assessed at the same measurement point. For a two-day lag, autocorrelations were significant for MMP8 (- 0.512) and MMP9 (- 0.302) and for cross-correlations between MMP8 and MMP9 (- 0.439), MMP8 and MMP12 (- 0.416), and MMP9 and MMP12 (- 0.307). Moreover, median MMP3, MMP10, and MMP13 levels significantly increased from admission to day 3 and significantly decreased from day 3 to day 10, showing similar time trajectories and an (almost) strong association between every 2 levels until day 7. Significant cross-correlations were detected between MMP3 and MMP10 (0.414) and MMP13 and MMP10 (0.362). Finally, the MMP10 day 0 level was identified as a predictor for in-hospital mortality. Any increase of the MMP10 level by 200 pg/mL decreased the odds of dying by 28.5%.
CONCLUSIONS: The time trajectories of the highly varying individual MMP levels elucidate the involvement of these enzymes in the endogenous defense response following polytrauma. Similar time courses of MMP levels might indicate similar injury causes, whereas lead-lag effects reveal causative relations between several enzyme pairs. Finally, MMP10 abundantly released into circulation after polytrauma might have a protective effect against dying.
METHODS: We evaluated 24 blunt polytrauma survivors and 12 fatalities (mean age, 44.2 years, mean ISS, 45) who were directly admitted to our Level I trauma center and stayed at the intensive care unit for at least one night. We determined their MMP3, MMP8, MMP9, MMP10, MMP12, and MMP13 serum levels at admission (day 0) and on days 1, 3, 5, 7, and 10.
RESULTS: Median MMP8, MMP9, and MMP12 levels immediately rose after the polytrauma occurred; however, they significantly decreased from admission to day 1 and significantly increased from day 1 to day 10, showing similar time trajectories and (very) strong correlations between each two of the three enzyme levels assessed at the same measurement point. For a two-day lag, autocorrelations were significant for MMP8 (- 0.512) and MMP9 (- 0.302) and for cross-correlations between MMP8 and MMP9 (- 0.439), MMP8 and MMP12 (- 0.416), and MMP9 and MMP12 (- 0.307). Moreover, median MMP3, MMP10, and MMP13 levels significantly increased from admission to day 3 and significantly decreased from day 3 to day 10, showing similar time trajectories and an (almost) strong association between every 2 levels until day 7. Significant cross-correlations were detected between MMP3 and MMP10 (0.414) and MMP13 and MMP10 (0.362). Finally, the MMP10 day 0 level was identified as a predictor for in-hospital mortality. Any increase of the MMP10 level by 200 pg/mL decreased the odds of dying by 28.5%.
CONCLUSIONS: The time trajectories of the highly varying individual MMP levels elucidate the involvement of these enzymes in the endogenous defense response following polytrauma. Similar time courses of MMP levels might indicate similar injury causes, whereas lead-lag effects reveal causative relations between several enzyme pairs. Finally, MMP10 abundantly released into circulation after polytrauma might have a protective effect against dying.
摘要：
背景：管理多发性创伤患者对临床医生提出了重大挑战，因为对具有相似损伤模式的患者应用相同的治疗可能会导致不同的结果。使用血清生物标志物有望以最佳的个体方式治疗每个多发性损伤。由于基质金属蛋白酶（MMPs）在各种生理过程中起着关键作用，它们可能是多重创伤护理的可靠工具。
方法：我们评估了24例钝性多发性创伤幸存者和12例死亡(平均年龄，44.2年,意味着国际空间站，45），他们直接进入我们的I级创伤中心，并在重症监护病房住了至少一个晚上。我们测定了入院时（第0天）和第1、3、5、7和10天的MMP3、MMP8、MMP9、MMP10、MMP12和MMP13血清水平。
结果：多发伤发生后，MMP8、MMP9和MMP12水平中位数立即上升；然而，从入院到第1天显着下降，从第1天到第10天显着增加，显示出相似的时间轨迹，并且在同一测量点评估的三种酶水平中的每两种之间（非常）强的相关性。为了两天的滞后，MMP8(-0.512)和MMP9(-0.302)的自相关以及MMP8和MMP9(-0.439)的交叉相关显著，MMP8和MMP12（-0.416），MMP9和MMP12（-0.307）。此外，MMP3,MMP10和MMP13水平中位数从入院到第3天显着增加,从第3天到第10天显着降低,显示出相似的时间轨迹,并且直到第7天,每2个水平之间存在(几乎)强关联.在MMP3和MMP10（0.414）以及MMP13和MMP10（0.362）之间检测到显着的交叉相关。最后,MMP10第0天水平被确定为院内死亡率的预测因子.MMP10水平增加200pg/mL，死亡几率降低28.5％。
结论：高度变化的个体MMP水平的时间轨迹阐明了这些酶参与多发性创伤后的内源性防御反应。MMP水平的相似时间过程可能表明相似的损伤原因，而滞后效应揭示了几种酶对之间的因果关系。最后,多发性创伤后大量释放到循环中的MMP10可能具有防止死亡的保护作用。
方法：我们评估了24例钝性多发性创伤幸存者和12例死亡(平均年龄，44.2年,意味着国际空间站，45），他们直接进入我们的I级创伤中心，并在重症监护病房住了至少一个晚上。我们测定了入院时（第0天）和第1、3、5、7和10天的MMP3、MMP8、MMP9、MMP10、MMP12和MMP13血清水平。
结果：多发伤发生后，MMP8、MMP9和MMP12水平中位数立即上升；然而，从入院到第1天显着下降，从第1天到第10天显着增加，显示出相似的时间轨迹，并且在同一测量点评估的三种酶水平中的每两种之间（非常）强的相关性。为了两天的滞后，MMP8(-0.512)和MMP9(-0.302)的自相关以及MMP8和MMP9(-0.439)的交叉相关显著，MMP8和MMP12（-0.416），MMP9和MMP12（-0.307）。此外，MMP3,MMP10和MMP13水平中位数从入院到第3天显着增加,从第3天到第10天显着降低,显示出相似的时间轨迹,并且直到第7天,每2个水平之间存在(几乎)强关联.在MMP3和MMP10（0.414）以及MMP13和MMP10（0.362）之间检测到显着的交叉相关。最后,MMP10第0天水平被确定为院内死亡率的预测因子.MMP10水平增加200pg/mL，死亡几率降低28.5％。
结论：高度变化的个体MMP水平的时间轨迹阐明了这些酶参与多发性创伤后的内源性防御反应。MMP水平的相似时间过程可能表明相似的损伤原因，而滞后效应揭示了几种酶对之间的因果关系。最后,多发性创伤后大量释放到循环中的MMP10可能具有防止死亡的保护作用。
