Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients
Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients
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DOI：
10.1016/j.resuscitation.2012.06.010
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发表时间：
2013-01-01
期刊：
影响因子：
6.5
通讯作者：
Cariou, A.
中科院分区：
文献类型：
--
作者：
Grimaldi, D.;Guivarch, E.;Cariou, A.
目的：肠道功能障碍被怀疑通过肠道通透性增加和内毒素释放在复苏后疾病的病理生理学中发挥重要作用。然而，这种功能障碍通常仍然是隐秘的，并且很少被研究。这项初步研究的目的是探索心脏骤停后患者的肠衰竭生物标志物，并将其与内毒素血症相关联。方法：在心脏骤停后复苏后，对 21 名患者进行了前瞻性研究。入院时、第 1-3 天和第 6 天测量了标志着肠道通透性的尿肠脂肪酸结合蛋白 (IFABP)、反映功能性肠上皮细胞质量的血浆瓜氨酸和全血内毒素。我们探讨了释放动力学以及 IFABP、瓜氨酸和内毒素值之间的关系。结果：IFABP 在入院时极高，并在入院时恢复正常。 D3（6668 pg/mL 与 39 pg/mL，p = 0.01）。瓜氨酸中位数最低（N = 20-40 μ mol/L）在 D2 时达到（D2 时为 11 μ mol/L，入院时为 24 μ mol/L，p = 0.01），并在 D6 时趋于正常化（21 μ mol/L）。在 ICU 住院期间，86% 的患者出现可检测到的内毒素血症。最高内毒素水平与最高 IFABP 水平呈正相关（R-2 = 0.31，p = 0.01），与最低血浆瓜氨酸水平呈负相关（R-2 = 0.55，p < 0.001）。在复苏后休克的患者中，内毒素水平在入院至 D2 期间升高，而在无休克的患者中则降低（中位数 +0.33 EU 与 -0.19 EU，p = 0.03）。最高内毒素水平与 D3 SOFA 评分呈正相关（R-2 = 0.45，p = 0.004）。结论：心脏骤停后肠道损伤的生物标志物发生改变，并且与内毒素血症相关。这可能会加剧复苏后休克和器官衰竭。 (C) 2012 Elsevier Ireland Ltd. 保留所有权利。
Aims: Gut dysfunction is suspected to play a major role in the pathophysiology of post-resuscitation disease through an increase in intestinal permeability and endotoxin release. However this dysfunction often remains occult and is poorly investigated. The aim of this pilot study was to explore intestinal failure biomarkers in post-cardiac arrest patients and to correlate them with endotoxemia.Methods: Following resuscitation after cardiac arrest, 21 patients were prospectively studied. Urinary intestinal fatty acid-binding protein (IFABP), which marks intestinal permeability, plasma citrulline, which reflects the functional enterocyte mass, and whole blood endotoxin were measured at admission, days 1-3 and 6. We explored the kinetics of release and the relationship between IFABP, citrulline and endotoxin values.Results: IFABP was extremely high at admission and normalized at D3 (6668 pg/mL vs 39 pg/mL, p = 0.01). Lowest median of citrulline (N = 20-40 mu mol/L) was attained at D2 (11 mu mol/L at D2 vs 24 mu mol/L at admission, p = 0.01) and tended to normalize at D6 (21 mu mol/L). During ICU stay, 86% of patients presented a detectable endotoxemia. Highest endotoxin level was positively correlated with highest IFABP level (R-2 = 0.31, p = 0.01) and was inversely correlated with lowest plasma citrulline levels (R-2 = 0.55, p < 0.001). Endotoxin levels increased between admission and D2 in patients with post-resuscitation shock, whereas it decreases in patients with no shock (median +0.33 EU vs -0.19 EU, p = 0.03). Highest endotoxin level was positively correlated with D3 SOFA score (R-2 = 0.45, p = 0.004).Conclusion: Biomarkers of intestinal injury are altered after cardiac arrest and are associated with endotoxemia. This could worsen post-resuscitation shock and organ failure. (C) 2012 Elsevier Ireland Ltd. All rights reserved.