@article{oai:twinkle.repo.nii.ac.jp:00020015,
 author = {TERADA, Takahiro and NAKAGAWA, Takao and YAGUCHI, Arino and OKAJIMA, Kenji and SUZUKI, Tadashi},
 issue = {12},
 journal = {東京女子医科大学雑誌},
 month = {Dec},
 note = {全身性炎症反応性症候群(SIRS)は侵襲に対する生体反応としてTNF-αなどの炎症性サイトカインにより引き起こされる.この中には,一過性で自然軽快に向かうSIRSと,重篤な感染症・組織障害を伴い多臓器障害(MOF)へと重症化するSIRSがあり,両者を早期に鑑別診断できれば重篤化を防ぐことができ臨床上の利点が大きい.E-selectinはセレクチンファミリーに属する単鎖糖蛋白で,血管内皮細胞に分布し内皮と好中球・単球等の接着に関与する細胞接着分子の一つであり,炎症性サイトカインにより誘導され,炎症性疾患や癌患者の血中に出現することが知られている.我々は血中soluble E-selectinに着目し,SIRS患者の重症度,予後,各臓器の機能不全との相関と重症患者の予後判定に有用か検討した.SIRSと診断されSOFAスコアーで3点以上を呈した症例50例を対象とし,第0,1,3,5,7病日にsE-selectinを測定し検討した.結果,来院時の血中sE-selectin値は第28病日の死亡群が生存群に比べ有意に高値を示し,その後の変動も死亡群で有意に高値が続き,患者の予後を推測できた.MOF群と非MOF群間の比較では,MOF群が有意に高値を示した.また,sE-selectinが上昇すると共に不全臓器数も増加しさらにSOFA scoreとsE-selectin値の変動は正の相関を認めた.またsE-selectin値と各臓器障害の相関をみると,呼吸器系の重症度を反映するPaO_2/F_1O_2比(P/F ratio)でsE-selectin値が最も有意に相関し,急性肺障害(ALI/ARDS)群とnon-ALI/non-ARDS群ではALI群でsE-selectin値が有意に上昇した.播種性血管内血液凝固症候群(DIC)群とnon-DIC群の間ではDIC群でsE-selectinが有意に高値を示し,DIG scoreとsE-selectin値の間でも正の相関を認めた.以上よりsE-selectinはDIC score・SOFA score・呼吸・凝固・腎臓の機能不全のみならず患者の生命予後とも相関することから,重症化や生命予後の有用な血中マーカーになると考えられた., Systemic inflammatory response syndrome (SIRS) is caused by proinflammatory cytokines, such as TNF-α. SIRS that is mild soon remit naturally but some SIRS are severe and may change into multiple organ failure (MOF) associated with serious infections and tissue damage. If early differential diagnosis were possible, early measures could be taken to prevent poor outcomes. Endothelial selectin (E-selectin) is a single-chain glycoprotein that belongs to the selectin family. It is distributed in vascular endothelial cells, and is one of the cell adhesion molecules that contribute to the adhesion between endothelial cells and neutrophils and monocytes. E-selectin is induced by proinflammatory cytokines, and it appears in the blood of inflammatory disease and cancer patients. In this study, we investigated the correlations between soluble E (sE) -selectin with severity, outcome, and functional failure of individual organs, and we assessed the usefulness of sE-selectin for judging outcome in severe cases. The subjects were 50 emergency patients brought to our center, diagnosed with SIRS and had a Sequential Organ Failure Assessment (SOFA) score of 3 or more. The method consisted of measuring sE-selectin on arrival at the hospital (day 0) and on hospital days 1, 3, 5, and 7, and then testing for correlations with organ failure and survival. The results showed patients who died within 28th hospital day either had significantly higher sE-selectin levels on arrival or continued to have high levels within 7 days of admission than those who survived. This finding made it possible to predict the outcome of the patients. MOF group showed significantly higher levels than the non-MOF group. The number of failing organs increased as the sE-selectin values rose, and there was a positive correlation between the changes in SOFA scores and sE-selectin values. Testing for correlations between the sE-selectin values and each organ failure showed that the serum sE-selectin levels were most significantly correlated with the PaO_2/FiO_2 ratio (P/F ratio), which reflects the degree of failure to the respiratory system. In addition, comparison of the acute lung injury (ALI)/adult respiratory distress syndrome (ARDS) group and the non-ALI/non-ARDS group showed that the sE-selectin levels were significantly higher in the ALI group. A significant correlation was also found between the sE-selectin values and DIG score. Furthermore, the sE-selectin levels also significantly increased in the DIG than in non-DIC group. Based on the above findings, sE-selectin measurements correlated with DIG scores, SOFA scores, functional failure of the respiratory system, coagulation, and kidney. Since the sE-selectin level also correlated with patient survival, it may be a useful blood marker for predicting severity outcome and survival in critically-ill patients.},
 pages = {467--476},
 title = {Soluble Endothelium-selectin (sE-selectin) in Critically III Patients},
 volume = {76},
 year = {2006}
}