Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness
Pathophysiological and diagnostic implications of cardiac biomarkers and antidiuretic hormone release in distinguishing immersion pulmonary edema from decompression sickness
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DOI：
10.1097/md.0000000000004060
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发表时间：
2016-06-01
期刊：
影响因子：
1.6
通讯作者：
Fenouillet, Emmanuel
中科院分区：
文献类型：
--
作者：
Louge, Pierre;Coulange, Mathieu;Fenouillet, Emmanuel
浸没性肺水肿（IPE）是一种误诊的环境疾病，由水浸泡，寒冷和劳累引起。IPE通常发生在水肺潜水，浮潜和游泳期间。IPE有时与心肌损伤和/或水中意识丧失有关，这可能是致命的。IPE被认为涉及血流动力学和心血管紊乱，但其病理生理学仍不清楚，这使得IPE的预防困难。本观察性研究旨在记录IPE发病机制并提高诊断可靠性，包括在某些条件下区分IPE与减压病（DCS），另一种潜水相关disorder.31例患者（19 IPE，12 DCS）在高压医学部（Ste-Anne医院，土伦，法国; 2013年7月至2014年6月）被招募到研究中。10名健康潜水员作为对照组。我们测试了：（i）和肽素，抗利尿激素的替代标记物和应激标记物;（ii）缺血修饰的白蛋白，缺血/缺氧标记物;（iii）脑利钠肽（BNP），心力衰竭标记物;和（iv）超敏心肌肌钙蛋白I（cTnI），心肌缺血标记物。我们发现，和肽素和心脏生物标记物在IPE中高于DCS和对照组：（i）和肽素：68%的IPE患者有高水平，而DCS患者为25%（P
Immersion pulmonary edema (IPE) is a misdiagnosed environmental illness caused by water immersion, cold, and exertion. IPE occurs typically during SCUBA diving, snorkeling, and swimming. IPE is sometimes associated with myocardial injury and/or loss of consciousness in water, which may be fatal. IPE is thought to involve hemodynamic and cardiovascular disturbances, but its pathophysiology remains largely unclear, which makes IPE prevention difficult. This observational study aimed to document IPE pathogenesis and improve diagnostic reliability, including distinguishing in some conditions IPE from decompression sickness (DCS), another diving-related disorder.Thirty-one patients (19 IPE, 12 DCS) treated at the Hyperbaric Medicine Department (Ste-Anne hospital, Toulon, France; July 2013-June 2014) were recruited into the study. Ten healthy divers were recruited as controls. We tested: (i) copeptin, a surrogate marker for antidiuretic hormone and a stress marker; (ii) ischemia-modified albumin, an ischemia/hypoxia marker; (iii) brain-natriuretic peptide (BNP), a marker of heart failure, and (iv) ultrasensitive-cardiac troponin-I (cTnI), a marker of myocardial ischemia.We found that copeptin and cardiac biomarkers were higher in IPE versus DCS and controls: (i) copeptin: 68% of IPE patients had a high level versus 25% of DCS patients (P