A prospective, observational study of soluble FLT-1 and vascular endothelial growth factor in sepsis
A prospective, observational study of soluble FLT-1 and vascular endothelial growth factor in sepsis
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DOI：
10.1097/shk.0b013e31815072c1
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发表时间：
2008-04-01
期刊：
影响因子：
3.1
通讯作者：
Aird, William C.
中科院分区：
文献类型：
--
作者：
Shapiro, Nathan I.;Yano, Kiichiro;Aird, William C.
先前的小鼠和人类研究表明，血管内皮生长因子（VEGF）有助于内皮细胞活化和败血症疾病的严重程度。此外，发现可溶性VEGF受体1（sFLT）水平的循环水平增加，作为小鼠对脓毒症的早期反应的一部分。本研究的目的是评估因疑似感染而到急诊科（艾德）就诊的患者的游离VEGF-A和sFLT的血液水平，并评估这些水平与疾病严重程度和炎症的关系。这是一项前瞻性、观察性研究，在一家城市三级医疗大学医院的艾德急诊室开展。入选标准为（1）年龄≥ 18岁的艾德患者和（2）临床疑似感染。我们重新招募了83名患者。主要发现是：（1）在以下组中平均VEGF和sFLT水平逐渐升高：未感染的对照组、无休克的感染组和感染性休克组;（2）初始和24小时VEGF水平与24小时感染性休克的存在显著相关;（3）sFLT水平与急性生理学评分、年龄、慢性健康状况评分、脓毒症相关器官衰竭评分相关;（4）VEGF和sFLT水平与炎症级联反应相关。这是首次报道sFLT作为脓毒症患者严重程度的潜在新标志物。血管内皮细胞生长因子及其信号轴在内皮细胞对脓毒症的反应中是重要的，进一步阐明这些机制可能会导致未来诊断和治疗机会的进展。
Prior murine and human studies suggest that vascular endothelial growth factor (VEGF) contributes to endothelial cell activation and severity of illness in sepsis. Furthermore, circulating levels of soluble VEGF receptor 1 (sFLT) levels were found to increase as part of the early response to sepsis in mice. The objective of the study was to evaluate the blood levels of free VEGF-A and sFLT in patients presenting to the emergency department (ED) with suspected infection and to assess the relationship of these levels with severity of illness and inflammation. It was a prospective, observational study initiated in the ED of an urban, tertiary care, university hospital. Inclusion criteria were (1) ED patients aged 18 years or older and (2) clinical suspicion of infection. Eighty-three patients we re enrolled in the study. The major findings were that (1) the mean VEGF and sFLT levels were increasingly higher across the following groups: noninfected control patients, infected patients without shock, and septic shock patients; (2) initial and 24-h VEGF levels had a significant correlation with the presence of septic shock at 24 h; (3) initial and 24-h sFLT levels correlated with Acute Physiology Age Chronic Health Evaluation It and Sepsis-related Organ Failure Assessment scores initially and at 24 h; and (4) VEGF and sFLT levels correlated with inflammatory cascade activation. This is the first report of sFLT as a potential new marker of severity in patients with sepsis. Vascular endothelial cell growth factor and its signaling axis are important in the endothelial cell response to sepsis, and further elucidation of these mechanisms may lead to advances in future diagnostic and therapeutic opportunities.