Abstract

The concentrations of several diagnostic markers have been found to increase dramatically in critically ill patients with a severe disturbance of normal physiological homeostasis, without indication of the diseases they are normally associated with. To prevent false diagnoses and inappropriate treatments of critically ill patients, it is important that the markers aiding the selection of second-line treatments are evaluated in such patients and not only in the healthy population and patients with diseases the markers are associated with. The levels of trypsinogen isoenzymes, the trypsin inhibitor serine peptidase inhibitor Kazal type 1 (SPINK1), hCG and hCGβ, which are used as pancreatitis and cancer markers, were analyzed by immunoassays from serum samples of 17 adult patients who have undergone surgery of the ascending aorta during hypothermic circulatory arrest (HCA) with optional selective cerebral perfusion. Highly elevated levels of trypsinogen-1, -2 and -3, SPINK1 and hCGβ were observed in patients after HCA. This was accompanied by increased concentrations of S100β and NSE. In conclusion, this study highlights the importance of critically evaluating the markers used for aiding selection of second line of treatments in critically ill patients.

摘要

已经发现，在正常生理稳态严重紊乱的危重病人中，几种诊断标志物的浓度显着增加，而没有迹象表明它们通常与疾病相关。为了防止对危重患者的错误诊断和不当治疗，重要的是在这些患者中评估有助于选择二线治疗的标志物，而不仅仅是在健康人群和患有该标志物相关疾病的患者中进行评估。胰蛋白酶原同工酶、胰蛋白酶抑制剂丝氨酸肽酶抑制剂 Kazal 1 型 (SPINK1)、hCG 和 hCGβ 的水平，用作胰腺炎和癌症标志物，通过对 17 名在低温循环骤停 (HCA) 期间接受升主动脉手术并可选择选择性脑灌注的成年患者的血清样本进行免疫测定分析。在 HCA 后的患者中观察到胰蛋白酶原-1、-2 和 -3、SPINK1 和 hCGβ 水平高度升高。这伴随着 S100β 和 NSE 浓度的增加。总之，这项研究强调了批判性评估用于帮助危重患者选择二线治疗的标志物的重要性。