An increase in serum C18 unsaturated free fatty acids as a predictor of the development of acute respiratory distress syndrome
An increase in serum C18 unsaturated free fatty acids as a predictor of the development of acute respiratory distress syndrome
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DOI：
10.1097/00003246-199607000-00011
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发表时间：
1996-07-01
影响因子：
8.8
通讯作者：
Repine, JE
中科院分区：
文献类型：
--
作者：
Bursten, SL;Federighi, DA;Repine, JE
目的：急性呼吸窘迫综合征（ARDS）是败血症、创伤和多种临床疾病的并发症，目前尚无预测ARDS的方法。由于激活磷脂信号通路，包括酰基链油酸酯和亚油酸酯可能会启动和放大炎症反应，从而导致发展的ARDS，我们研究了这些生物活性脂质的血清浓度是否增加，并预测ARDS在高危patients.Design：第一部分：一个前瞻性的，单盲试验。第二部分：一项前瞻性，随机，双盲试验。设置：一般强化治疗单位在五所大学教学hospitals.Subjects：第一部分：39名健康对照患者进行了研究，以确定血清酰基值的正态分布，其次是30名患者入院与发病败血症，创伤，或发展的ARDS（入院后24小时内）超过1年的时间。第二部分：8例脓毒症综合征患者入院超过2个月periods.Interventions：第二部分：患者随机接受替代甲基黄嘌呤，伊索茶碱（CT1501R），或相同的安慰剂。我们测量了39名健康对照者的血清游离脂肪酸浓度，然后，我们前瞻性地检测了30名年龄匹配的患者在脓毒症、创伤或ARDS发作后24小时内获得的血清游离脂肪酸浓度。然后，我们前瞻性地研究了8名脓毒症高危患者，这些患者在年龄、急性生理学和慢性健康评估II评分、多器官衰竭指数和格拉斯哥昏迷评分方面相匹配，这是一项双盲、安慰剂对照的初步研究。这些患者包括4名未接受治疗的患者和4名接受异茶碱治疗的患者，异茶碱是一种降低血清不饱和游离脂肪酸并减少脓毒症和/或创伤引起的动物急性肺损伤的化合物。血清游离脂肪酸的计算比率（即，C18不饱和脂肪酸亚油酸酯和油酸酯与完全饱和的棕榈酸酯的比率（C16：0）增加，并预测危险患者中ARDS的发展。在脓毒症、创伤或ARDS发生后24小时内采集的30例患者的血清样本，其平均酰基链比率（1.42 ± 0.35 [SD]）与健康对照组（0.86 ± 0.25; p
Objective: No means exist for predicting the acute respiratory distress syndrome (ARDS), which complicates sepsis, trauma, and a variety of clinical disorders. Because activation of phospholipid-signaling pathways involving the acyl chains oleate and linoleate may initiate and amplify the inflammatory response, and thereby lead to the development of ARDS, we examined whether serum concentrations of these bioactive lipids increase and are predictive of ARDS in at-risk patients.Design: Part I: A prospective, single-blind trial. Part II: A prospective, randomized, double-blind trial.Setting: General intensive therapy units in five university teaching hospitals.Subjects: Part I: Thirty-nine healthy control patients were studied to determine normal distribution of serum acyl values, followed by 30 patients admitted with onset of sepsis, trauma, or development of ARDS (within 24 hrs of admission) over a 1-yr period. Part II: Eight patients admitted with sepsis syndrome over a 2-month period.Interventions: Part II: Patients were randomized to receive the substituted methylxanthine, llsofylline (CT1501R), or an identically presented placebo.Measurements and Main Results: We measured the serum free fatty acid concentrations in the 39 healthy control subjects, and then we prospectively examined the serum free fatty acid concentrations in 30 age-matched patients in samples obtained within 24 hrs from the onset of sepsis, trauma, or development of ARDS. We then prospectively studied eight septic, at risk patients who were matched for age, Acute Physiology and Chronic Health Evaluation II scores, Multiple Organ Failure Index, and Glasgow Coma Score, in a double blind, placebo-controlled, pilot study. These patients included four patients who received no treatment and four patients who received lisofylline, a compound that decreases serum unsaturated free fatty acids and diminishes acute lung injury in animals caused by sepsis and/or trauma. The calculated ratios of serum free fatty acids (i.e., the ratio of C18 unsaturated fatty acids linoleate and oleate to fully saturated palmitate, C16:0) increased and predicted the development of ARDS in at risk patients. Serum samples from the 30 patients, obtained within 24 hrs from the onset of sepsis, trauma, or development of ARDS, had significantly increased mean acyl chain ratios (1.42 +/- 0.35 [SD]) compared with healthy control subjects (0.86 +/- 0.25; p