Human endothelial impairment in sepsis
Human endothelial impairment in sepsis
复制标题
DOI：
10.1016/j.atherosclerosis.2007.07.009
复制
发表时间：
2008-04-01
期刊：
影响因子：
5.3
通讯作者：
Mannarino, Elmo
中科院分区：
文献类型：
--
作者：
Vaudo, Gaetano;Marchesi, Simona;Mannarino, Elmo
脓毒症的发病通常是非特异性的，其严重程度是神秘的。脓毒症发展的病理生理机制涉及血管改变，特别是内皮功能的损害。该研究的目的是评估在革兰氏阴性脓毒症患者中肱内皮功能评估的潜在意义。纳入45例年轻革兰氏阴性脓毒症患者（平均年龄418岁，18岁）；入院时（TO）体征和症状，收集临床和实验室资料；在入路时评估序贯器官衰竭评估（SOFA）评分，并评估肱血流介导的血管舒张（FMV）。住院后3天（T1）重复相同参数。住院时的研究人群以肱FMV切断为基础进行划分：在T0时，FMV < 7.5%的受试者与FMV≥7.5%的受试者相比，白细胞计数较低（6693 +/- 1559 mmc vs 14270 +/- 2399 mmc）；FMV < 7.5%的受试者T1时SOFA评分显著升高（4 +/- 1比6 +/- 1），T1时肱FMV显著降低（4.8 +/- 2.7%比3.7 +/- 2.6%）（均p < 0.05）。入院时FMV由白细胞（β = 0.65, p < 0.001）和肱直径（β = -0.292, p < 0.05）预测；通过SOFA评分的变化预测FMV的变化（β = -0.41; p < 0.05）。总之，本研究表明，在脓毒症的初始阶段，肱FMV的损害预示着器官衰竭的进展；这些考虑支持了臂丛FMV在急性病理脓毒症的临床实践中的潜在效用。2007爱思唯尔爱尔兰有限公司版权所有。
The onset of sepsis is often non-specific, and its severity is cryptic. The pathophysiological mechanism of sepsis development involves vascular alteration and, in particular, the impairment of endothelial function. Aim of the study was to evaluate the potential implications of brachial endothelial function assessment in patients affected by Gram-negative sepsis. Forty-five young patients (mean age 41 8 years, 18 mates) with Gram-negative sepsis were included; at admission time (TO) signs and symptoms, clinical and laboratory data were collected; the Sequential Organ Failure Assessment (SOFA) score was assessed at the time of the access along with the evaluation of brachial flow-mediated vasodilation (FMV). The same parameters were repeated 3 days after hospitalization (T1). Study population at the hospitalization time was divided on the basis of a brachial FMV cut off: at the T0 subjects with FMV < 7.5% had lower white blood cell count in comparison to subjects with FMV > 7.5% (6693 +/- 1559 mmc versus 14,270 +/- 2399 mme); subjects with FMV < 7.5% had a significant increase in SOFA score at T1 (4 +/- 1 versus 6 +/- 1) and a significant reduction of brachial FMV at T1 (4.8 +/- 2.7% versus 3.7 +/- 2.6%) (all p < 0.05). FMV at the admission time was predicted by white blood cells (beta = 0.65; p < 0.001) and brachial diameter (beta = -0.292; p < 0.05); A changes in FMV were predicted by changes in SOFA score ( beta= -0.41; p < 0.05). In conclusion, the present study indicates that in the initial phase of sepsis an impairment of brachial FMV anticipated the progression in organ failures; these considerations support the potential utility of brachial FMV in clinical practice in acute pathologies as septic state. (c) 2007 Elsevier Ireland Ltd. All rights reserved.