Modelling the dynamic interaction of systemic inflammation and the hypothalamic-pituitary-adrenal (HPA) axis during and after cardiac surgery.
Modelling the dynamic interaction of systemic inflammation and the hypothalamic-pituitary-adrenal (HPA) axis during and after cardiac surgery.
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模拟心脏手术期间和之后全身炎症和下丘脑-垂体-肾上腺（HPA）轴的动态相互作用。
DOI：
10.1098/rsif.2021.0925
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发表时间：
2022-04
期刊：
影响因子：
--
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中科院分区：
文献类型：
--
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大手术和危重疾病会产生潜在威胁生命的全身性炎症反应。下丘脑-垂体-肾上腺(HPA)轴是通过改变促肾上腺皮质激素(ACTH)和皮质醇来平衡全身炎症的关键生理系统之一。这些激素通常表现出高度相关的超传统脉动性，其幅度受昼夜节律的调节。然而，这些动态会被大手术和危重疾病扰乱。在这项工作中，我们描述了心脏手术患者的炎症、ACTH和皮质醇反应，并表明HPA轴反应可以分为三种表型之一：单脉冲、双脉冲和多脉冲动力学。我们开发了一个皮质醇分泌和代谢的数学模型，预测了导致这些不同表型的生理机制。我们发现，炎症介质的作用只有在失去正常搏动性的单脉模式中才重要--这表明这种表型可以指示最大的炎症反应。调查这些表型是否以及如何与临床结果相关，将对患者预后和设计改善康复的干预措施至关重要。
Major surgery and critical illness produce a potentially life-threatening systemic inflammatory response. The hypothalamic–pituitary–adrenal (HPA) axis is one of the key physiological systems that counterbalances this systemic inflammation through changes in adrenocorticotrophic hormone (ACTH) and cortisol. These hormones normally exhibit highly correlated ultradian pulsatility with an amplitude modulated by circadian processes. However, these dynamics are disrupted by major surgery and critical illness. In this work, we characterize the inflammatory, ACTH and cortisol responses of patients undergoing cardiac surgery and show that the HPA axis response can be classified into one of three phenotypes: single-pulse, two-pulse and multiple-pulse dynamics. We develop a mathematical model of cortisol secretion and metabolism that predicts the physiological mechanisms responsible for these different phenotypes. We show that the effects of inflammatory mediators are important only in the single-pulse pattern in which normal pulsatility is lost—suggesting that this phenotype could be indicative of the greatest inflammatory response. Investigating whether and how these phenotypes are correlated with clinical outcomes will be critical to patient prognosis and designing interventions to improve recovery.
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DOI：
10.1186/s13054-014-0721-8
发表时间：
2015-01-06
期刊：
Critical care (London, England)
影响因子：
--
作者：
de Jong MF;Molenaar N;Beishuizen A;Groeneveld AB
通讯作者：
Groeneveld AB
DOI：
10.1056/nejmoa1214969
发表时间：
2013-04-18
期刊：
The New England journal of medicine
影响因子：
--
作者：
Boonen E;Vervenne H;Meersseman P;Andrew R;Mortier L;Declercq PE;Vanwijngaerden YM;Spriet I;Wouters PJ;Vander Perre S;Langouche L;Vanhorebeek I;Walker BR;Van den Berghe G
通讯作者：
Van den Berghe G
影响因子：
2
作者：
Keenan, DM;Chattopadhyay, S;Veldhuis, JD
通讯作者：
Veldhuis, JD
影响因子：
3.4
作者：
Becher, Robert D.;Hoth, J. Jason;Chang, Michael C.
通讯作者：
Chang, Michael C.
影响因子：
7.7
作者：
Malek, Hamed;Ebadzadeh, Mohammad Mehdi;Zaringhalam, Jalal
通讯作者：
Zaringhalam, Jalal