Hyaluronic acid is associated with organ dysfunction in acute respiratory distress syndrome.
Hyaluronic acid is associated with organ dysfunction in acute respiratory distress syndrome.
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DOI：
10.1186/s13054-017-1895-7
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发表时间：
2017-12-14
期刊：
影响因子：
--
通讯作者：
Mikacenic C
中科院分区：
文献类型：
--
作者：
Esposito AJ;Bhatraju PK;Stapleton RD;Wurfel MM;Mikacenic C
透明质酸(HA)是一种细胞外基质成分，在局部组织损伤或应激时会被降解。在不同的肺损伤动物模型中，HA被证明在调节炎症和损伤方面发挥了机制作用。虽然HA存在于急性呼吸窘迫综合征(ARDS)患者的肺中，但其与患者预后的关系尚不清楚。我们研究了86名ARDS患者，这些患者之前在北美五个医疗中心参加了鱼油治疗急性肺损伤患者的第二阶段随机试验(NCT00351533)。我们检查了ARDS诊断后48小时内获得的配对血清和支气管肺泡灌洗液(BALF)样本。我们通过回归分析调整了年龄、性别、种族、治疗组和ARDS的危险因素，评估了血清和BALF中HA水平与器官功能障碍的局部(肺损伤评分(LIS))和全身(序贯器官衰竭评估评分(SOFA))的相关性。我们发现，第0天循环和肺泡HA水平均与LIS恶化有关(分别为p = 0.04和p = 0.003)，特别是通过与低氧血症程度(分别为p = 0.02和p <； 0.001)和设定呼气末正压(分别为p = 0.01和p = 0.02)的关系。循环HA与SOFA评分(p <； 0.001)相关，与呼吸(p = 0.02)、凝血(p <； 0.001)、肝脏(p = 0.006)和肾脏(p = 0.01)相关。值得注意的是，肺泡HA水平与SOFA评分中的呼吸成分相关(p = 0.003)，但与综合SOFA评分无关(p = 0.27)。肺泡透明质酸水平升高与LIS有关，而循环水平与肺损伤和SOFA评分有关。这些发现表明，HA在ARDS患者的局部和全身器官功能障碍中具有潜在的作用。本文的在线版本(doi：10.1186/s13054-0171895-7)包含补充材料，授权用户可以使用。
Hyaluronic acid (HA), an extracellular matrix component, is degraded in response to local tissue injury or stress. In various animal models of lung injury, HA has been shown to play a mechanistic role in modulating inflammation and injury. While HA is present in the lungs of patients with acute respiratory distress syndrome (ARDS), its relationship to patient outcomes is unknown. We studied 86 patients with ARDS previously enrolled in the Phase II Randomized Trial of Fish Oil in Patients with Acute Lung Injury (NCT00351533) at five North American medical centers. We examined paired serum and bronchoalveolar lavage fluid (BALF) samples obtained within 48 hours of diagnosis of ARDS. We evaluated the association of HA levels in serum and BALF with local (lung injury score (LIS)) and systemic (sequential organ failure assessment score (SOFA)) measures of organ dysfunction with regression analysis adjusting for age, sex, race, treatment group, and risk factor for ARDS. We found that both day-0 circulating and alveolar levels of HA were associated with worsening LIS (p = 0.04 and p = 0.003, respectively), particularly via associations with degree of hypoxemia (p = 0.02 and p < 0.001, respectively) and set positive end-expiratory pressure (p = 0.01 and p = 0.02, respectively). Circulating HA was associated with SOFA score (p < 0.001), driven by associations with the respiratory (p = 0.02), coagulation (p < 0.001), liver (p = 0.006), and renal (p = 0.01) components. Notably, the alveolar HA levels were associated with the respiratory component of the SOFA score (p = 0.003) but not the composite SOFA score (p = 0.27). Elevated alveolar levels of HA are associated with LIS while circulating levels are associated with both lung injury and SOFA scores. These findings suggest that HA has a potential role in both local and systemic organ dysfunction in patients with ARDS. The online version of this article (doi:10.1186/s13054-017-1895-7) contains supplementary material, which is available to authorized users.
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DOI：
10.1165/ajrcmb/8.3.299
发表时间：
1993-03-01
影响因子：
6.4
作者：
JUUL, SE;KINSELLA, MG;HODSON, WA
通讯作者：
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DOI：
10.1164/rccm.201511-2281oc
发表时间：
2016-08-15
影响因子：
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