Iso-osmolar prehydration shifts the cytokine response towards a more anti-inflammatory balance in human endotoxemia
Iso-osmolar prehydration shifts the cytokine response towards a more anti-inflammatory balance in human endotoxemia
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DOI：
10.1179/096805105x58715
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发表时间：
2005-01-01
期刊：
影响因子：
--
通讯作者：
Pickkers, P
中科院分区：
文献类型：
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作者：
Dorresteijn, MJ;van Eijk, LT;Pickkers, P
临床经验表明，在人类内毒素血症中给予液体可以减轻症状。在本研究中，标准化液体方案对人类内毒素血症的症状、炎症和血流动力学参数的影响被确定。在当地伦理委员会的批准下，16名健康志愿者注射了2 ng/kg的大肠杆菌内毒素(O：113)。在隔夜禁食后，9名受试者在注射内毒素前一小时注射1.5 L 2.5%葡萄糖/0.45%氯化钠溶液，并在实验过程中以150ml/h的速度注射(预水化组)。7名受试者在实验期间只接受了75ml/h的持续输液(非预水化组)。测定炎症参数和症状的病程，测量平均动脉压、心率和前臂血流量。预水化组肿瘤坏死因子-α升高至522+/-63pg/ml(均值+/-扫描电子显微镜)，而非预水化组最高为927+/-187pg/ml(P<；0.04)。IL-10在两组中升高相似(未预水117+/-18pg/ml和预水99+/-18pg/ml；P=NS)。预补液组症状评分明显低于对照组(P<；0.004)，且恢复较快(P=0.004)。内毒素引起的血流动力学改变在两组之间没有显著差异。我们证明，在实验性人类内毒素血症中，预水化显著改变了细胞因子的平衡，使其向更抗炎的模式转变。这种效应与症状的减轻有关，而血流动力学参数的变化不受预水化的影响。
Clinical experience suggests that the administration of fluids in human endotoxemia reduces symptoms. In the present study, the effects of a standardised fluid protocol on symptoms, inflammatory and hemodynamic parameters in human endotoxemia are determined. With approval of the local ethics committee, 16 healthy volunteers received 2 ng/kg of Escherichia coli endotoxin (O:113). After an overnight fast, nine subjects received 1.5 l of 2.5% glucose/0.45% NaCl the hour prior to the endotoxin administration and 150 ml/h during the course of the experiment ('prehydrated group'). Seven subjects only received a continuous infusion of 75 ml/h during the experiment ('non-prehydrated group'). The course of inflammatory parameters and symptoms were determined and mean arterial pressure, heart rate and forearm blood flow were measured. In the prehydrated group, TNF-alpha increased to 522 +/- 63 pg/ml (mean +/- SEM) while the maximum in the non-prehydrated group was 927 +/- 187 pg/ml (P < 0.04). IL-10 increased similarly in both groups (non-prehydrated 117 +/- 18 pg/ml and prehydrated 99 +/- 18 pg/ml; P = NS). The prehydrated group had a significantly lower (P < 0.004) symptom score and recovered sooner (P = 0.004). Endotoxin-induced changes in hemodynamics revealed no significant differences between groups. We demonstrate that prehydration in experimental human endotoxemia significantly shifts the cytokine balance towards a more anti-inflammatory pattern. This effect is associated with a reduction in symptoms, whereas the changes in hemodynamic parameters are not influenced by prehydration.