Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-Like" syndrome
Successful cardiopulmonary resuscitation after cardiac arrest as a "sepsis-Like" syndrome
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DOI：
10.1161/01.cir.0000023891.80661.ad
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发表时间：
2002-07-30
期刊：
影响因子：
37.8
通讯作者：
Cavaillon, JM
中科院分区：
文献类型：
--
作者：
Adrie, C;Adib-Conquy, M;Cavaillon, JM
背景-我们调查了心脏骤停后成功复苏的患者的免疫炎症情况，这代表了全身缺血/再灌注综合征的模型。方法和结果-分别测定了61例、35例和11例患者全血中血浆细胞因子、内毒素和体外细胞因子的产生。入院时，血浆IL-6、IL-8、IL-10和可溶性肿瘤坏死因子受体11的高水平可以区分存活和死亡。在死亡患者中，最初需要血管升压剂与第1天IL-1受体拮抗剂、IL-10和IL-6水平较高有关。在分析的头两天内，46%的患者检测到血浆内毒素。与健康对照组相比，内毒素诱导的肿瘤坏死因子和白介素6的产生在这些患者中显著受损，而热致死的金黄色葡萄球菌的产生没有改变。相反，与健康对照组相比，这些患者IL-1受体拮抗剂的产生增加。这些患者的T细胞来源的IL-10和干扰素-γ的产生也受到损害。最后，利用健康对照组和患者之间的体外血浆交换，我们证明了内毒素依赖的低反应性是患者白细胞的固有属性，他们的血浆中也存在免疫抑制活性。结论--总之，这些患者中发现的高水平循环细胞因子、血浆中内毒素的存在以及细胞因子的异常产生使人想起脓毒症患者的免疫学特征。
Background-We investigated the immunoinflammatory profile of patients successfully resuscitated after cardiac arrest, representing a model of whole-body ischemia/reperfusion syndrome.Methods and Results-Plasma cytokine, endotoxin, and ex vivo cytokine production in whole-blood assays was assessed in 61, 35, and 11 patients, respectively. On admission, high levels of plasma interleukin (IL)-6, IL-8, IL-10, and soluble tumor necrosis factor (TNF) receptor type 11 could discriminate between survivors and nonsurvivors. Among nonsurvivors, the initial need for a vasopressor agent was associated with higher levels of IL-1 receptor antagonist, IL-10, and IL-6 on day 1. Plasma endotoxin was detected in 46% of the analyzed patients within the 2 first days. Endotoxin-induced TNF and IL-6 productions were dramatically impaired in these patients compared with healthy control subjects, whereas an unaltered production was observed with heat-killed Staphylococcus aureus. In contrast, IL-1 receptor antagonist productions were enhanced in these patients compared with healthy control subjects. The productions of T-cell-derived IL-10 and interferon-gamma were also impaired in these patients. Finally, using in vitro plasma exchange between healthy control subjects and patients, we demonstrated that the endotoxin-dependent hyporeactivity was an intrinsic property of patients' leukocytes and that an immunosuppressive activity was also present in their plasma.Conclusions-Altogether, the high levels of circulating cytokines, the presence of endotoxin in plasma, and the dysregulated production of cytokines found in these patients recall tire immunological profile found in patients with sepsis.