Sepsis-associated microvascular dysfunction measured by peripheral arterial tonometry: an observational study.
Sepsis-associated microvascular dysfunction measured by peripheral arterial tonometry: an observational study.
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DOI：
10.1186/cc8055
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Anstey NM
中科院分区：
文献类型：
--
作者：
Davis JS;Yeo TW;Thomas JH;McMillan M;Darcy CJ;McNeil YR;Cheng AC;Celermajer DS;Stephens DP;Anstey NM
脓毒症有很高的死亡率，尽管在管理的进步。微循环和内皮功能障碍导致器官衰竭，需要更好的工具来评估微循环对连续治疗的反应。我们假设，外周动脉张力测定（PAT），一种新的用户独立的内皮依赖性微血管反应性的措施，将受损的比例败血症的严重程度和相关的内皮激活和血浆精氨酸浓度。在澳大利亚热带地区一家拥有350张床位的教学医院进行的观察性队列研究。在基线和2-4天后通过外周动脉张力计测量85名脓毒症成人和45名对照者的床边微血管反应性。微血管反应性与疾病严重程度、血浆L-精氨酸（一氧化氮合酶的底物）浓度和内皮活化生物标志物有关。基线反应性充血指数（RH-PAT指数），测量内皮依赖性微血管反应性;（平均值[95%CI]）在严重脓毒症中最低（1.57 [1.43-1.70]），在无器官衰竭的脓毒症中居中（1.85 [1.67-2.03]），在对照组中最高（2.05 [1.91-2.19]）; P < 0.00001。脓毒症患者基线RH-PAT指数的独立预测因子是APACHE II评分和平均动脉压，而不是血浆L-精氨酸或内皮活化标志物。低基线RH-PAT指数与最初2-4天内SOFA评分的增加显著相关（r =-0.37，P = 0.02）。内皮依赖性微血管反应性受损与脓毒症严重程度成比例，提示脓毒症时内皮一氧化氮生物利用度降低。外周动脉张力测定可能作为一种独立于使用者的方法，用于监测针对脓毒症内皮功能障碍的新型连续治疗的反应。
Sepsis has a high mortality despite advances in management. Microcirculatory and endothelial dysfunction contribute to organ failure, and better tools are needed to assess microcirculatory responses to adjunctive therapies. We hypothesised that peripheral arterial tonometry (PAT), a novel user-independent measure of endothelium-dependent microvascular reactivity, would be impaired in proportion to sepsis severity and related to endothelial activation and plasma arginine concentrations. Observational cohort study in a 350-bed teaching hospital in tropical Australia. Bedside microvascular reactivity was measured in 85 adults with sepsis and 45 controls at baseline and 2-4 days later by peripheral arterial tonometry. Microvascular reactivity was related to measures of disease severity, plasma concentrations of L-arginine (the substrate for nitric oxide synthase), and biomarkers of endothelial activation. Baseline reactive hyperaemia index (RH-PAT index), measuring endothelium-dependent microvascular reactivity; (mean [95% CI]) was lowest in severe sepsis (1.57 [1.43-1.70]), intermediate in sepsis without organ failure (1.85 [1.67-2.03]) and highest in controls (2.05 [1.91-2.19]); P < 0.00001. Independent predictors of baseline RH-PAT index in sepsis were APACHE II score and mean arterial pressure, but not plasma L-arginine or markers of endothelial activation. Low baseline RH-PAT index was significantly correlated with an increase in SOFA score over the first 2-4 days (r = -0.37, P = 0.02). Endothelium-dependent microvascular reactivity is impaired in proportion to sepsis severity and suggests decreased endothelial nitric oxide bioavailability in sepsis. Peripheral arterial tonometry may have a role as a user-independent method of monitoring responses to novel adjunctive therapies targeting endothelial dysfunction in sepsis.
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影响因子：
1.9
作者：
Chenzbraun, A;Levin, G;Goor, D
通讯作者：
Goor, D
影响因子：
8.8
作者：
ASTIZ, ME;DEGENT, GE;RACKOW, EC
通讯作者：
RACKOW, EC
影响因子：
8.8
作者：
Ince, C;Sinaasappel, M
通讯作者：
Sinaasappel, M
影响因子：
4.2
作者：
Chiarla, C;Giovannini, I;Castagneto, M
通讯作者：
Castagneto, M
DOI：
10.1073/pnas.87.21.8612
发表时间：
1990-11-01
影响因子：
11.1
作者：
HECKER, M;SESSA, WC;VANE, JR
通讯作者：
VANE, JR