Hypervolemia increases release of atrial natriuretic peptide and shedding of the endothelial glycocalyx.
Hypervolemia increases release of atrial natriuretic peptide and shedding of the endothelial glycocalyx.
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DOI：
10.1186/s13054-014-0538-5
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发表时间：
2014-10-13
期刊：
影响因子：
--
通讯作者：
Rehm M
中科院分区：
文献类型：
--
作者：
Chappell D;Bruegger D;Potzel J;Jacob M;Brettner F;Vogeser M;Conzen P;Becker BF;Rehm M
急性等容性血液稀释（ANH）和容量负荷（VL）是标准的血液保留程序。然而，VL与高血容量相关，这可能导致组织水肿、心肺并发症和延长住院时间。机体对高血容量的反应是心房利钠肽（ANP）从心脏释放。ANP已被证明恶化内皮糖萼，这是血管通透性屏障的重要组成部分。本研究旨在评价和比较ANH和VL过程中ANP的释放和对糖萼的损害。在心肺健康状况良好的患者择期手术前给予6%羟乙基淀粉130/0.4的ANH或VL（每组n =9）。我们测量了ANP在ANH或VL前后血浆中的浓度和糖萼的三种主要成分（透明质酸、硫酸肝素和辛德聚糖1）在血清中的浓度。同时测定尿中硫酸肝素和辛迪康1的水平。与ANH相比，VL （20 ml/kg）诱导ANP显著释放（约+100%，P <0.05），并使两种糖萼成分透明质酸和syndecan 1的血清浓度均升高（约80%，P <0.05）。在VL患者的尿液中也检测到syndecan 1的升高，但在ANH患者中未发现升高。两种方法均不影响硫酸乙酰肝素水平。这些数据表明，高血容量增加ANP的释放，并导致内皮糖萼脱落增强。这种扰动必须预料到会损害血管屏障，这意味着VL可能不像通常认为的那样安全，应该对其进行严格评估。
Acute normovolemic hemodilution (ANH) and volume loading (VL) are standard blood-sparing procedures. However, VL is associated with hypervolemia, which may cause tissue edema, cardiopulmonary complications and a prolonged hospital stay. The body reacts to hypervolemia with release of atrial natriuretic peptide (ANP) from the heart. ANP has been shown to deteriorate the endothelial glycocalyx, a vital part of the vascular permeability barrier. The aim of the present study was to evaluate and compare ANP release and damage to the glycocalyx during ANH and VL. ANH or VL with 6% hydroxyethyl starch 130/0.4 was administered prior to elective surgery in patients of good cardiopulmonary health (n =9 in each group). We measured concentrations of ANP in plasma and of three main constituent parts of the glycocalyx (hyaluronan, heparan sulfate and syndecan 1) in serum before and after ANH or VL. Heparan sulfate and syndecan 1 levels in urine were also determined. In contrast to ANH, VL (20 ml/kg) induced a significant release of ANP (approximately +100%, P <0.05) and increased the serum concentration of two glycocalyx constituents, hyaluronan and syndecan 1 (both by about 80%, P <0.05). Elevation of syndecan 1 was also detected in the urine of patients undergoing VL, but no increase was found in patients undergoing ANH. Heparan sulfate levels were not influenced by either procedure. These data suggest that hypervolemia increases the release of ANP and causes enhanced shedding of the endothelial glycocalyx. This perturbation must be expected to impair the vascular barrier, implying that VL may not be as safe as generally assumed and that it should be critically evaluated.
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DOI：
10.1186/cc6913
发表时间：
2008
期刊：
Critical care (London, England)
影响因子：
--
作者：
Bruegger D;Rehm M;Jacob M;Chappell D;Stoeckelhuber M;Welsch U;Conzen P;Becker BF
通讯作者：
Becker BF
影响因子：
8.8
作者：
Jacob, Matthias;Bruegger, Dirk;Becker, Bernhard F.
通讯作者：
Becker, Bernhard F.
影响因子：
5.7
作者：
Kumar, R;Chakraborty, I;Sehgal, R
通讯作者：
Sehgal, R
影响因子：
4.1
作者：
FRASER, JRE;LAURENT, TC;BAXTER, E
通讯作者：
BAXTER, E
影响因子：
8.8
作者：
Nisanevich, V;Felsenstein, I;Matot, I
通讯作者：
Matot, I