Circulating levels of vasoactive peptides in patients with acute bacterial meningitis
Circulating levels of vasoactive peptides in patients with acute bacterial meningitis
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DOI：
10.1007/s00134-009-1515-3
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发表时间：
2009-09-01
影响因子：
38.9
通讯作者：
Moller, Kirsten
中科院分区：
文献类型：
--
作者：
Berg, Ronan M. G.;Strauss, Gitte Irene;Moller, Kirsten
目的：急性细菌性脑膜炎（ABM）脑血流（CBF）异常的潜在机制尚不清楚。推定的介质包括血管活性肽，例如。 g。降钙素基因相关肽（CGRP）、血管活性肠肽（VIP）和内皮素-1（ET-1），所有这些都可能受到重症监护室使用的治疗干预措施的影响。我们测量了 ABM 患者和接受重症监护相关干预的健康志愿者的动脉水平以及这些肽的净脑流量。方法：在知情同意后，纳入了 7 名严重 ABM 和脓毒症患者和 15 名健康志愿者。通过 Kety-Schmidt 技术测量 ABM 患者（仅限基线研究）以及志愿者的基线、自愿过度通气期间、静脉注射脂多糖 (LPS) 后以及去甲肾上腺素输注期间的血管活性肽净脑流量。 结果：ABM 患者的动脉 CGRP 水平升高，但 VIP 或 ET-1 水平不升高，但不存在净脑流量。 CGRP 水平在过度换气期间和注射 LPS 后下降。任何组在任何时间都没有发生 VIP 的净脑通量。基线时志愿者中发生的 ET-1 脑外流在注射 LPS 后的志愿者和 ABM 患者中均不存在。结论：在 ABM 和脓毒症患者中，血管舒张肽 CGRP 的动脉浓度升高，但 VIP 和血管收缩剂 ET-1 的动脉浓度均不升高。健康人体内似乎存在 ET-1 的组成性脑输出，但在 LPS 后被消除
Purpose: The underlying mechanisms for cerebral blood flow (CBF) abnormalities in acute bacterial meningitis (ABM) are largely unknown. Putative mediators include vasoactive peptides, e. g. calcitonin-gene related peptide (CGRP), vasoactive intestinal peptide (VIP), and endothelin-1 (ET-1), all of which may be affected by therapeutic interventions used in the intensive care unit. We measured arterial levels as well as the net cerebral flux of these peptides in patients with ABM, and in healthy volunteers undergoing interventions relevant to intensive care.Methods: Seven patients with severe ABM and sepsis and fifteen healthy volunteers were included after informed consent. The net cerebral fluxes of vasoactive peptides were measured by the Kety-Schmidt technique in ABM patients (baseline study only), as well as in volunteers at baseline, during voluntary hyperventilation, after an intravenous injection of lipopolysaccharide (LPS), and during norepinephrine infusion.Results: The arterial levels of CGRP, but not of VIP or ET-1, were elevated in patients with ABM, but no net cerebral flux was present. CGRP levels decreased during hyperventilation and after LPS injection. No net cerebral flux of VIP occurred in any group at any time. A cerebral efflux of ET-1, which occurred in volunteers at baseline, was neither present in volunteers after LPS injection nor in patients with ABM.Conclusion: The arterial concentration of the vasodilatory peptide, CGRP, but of neither VIP nor the vasoconstrictor ET-1, is elevated in patients with ABM and sepsis. A constitutive cerebral output of ET-1 appears to be present in healthy humans, but is abolished after LPS