The effect of prostacyclin infusion on markers of endothelial activation and damage in mechanically ventilated patients with SARS-CoV-2 infection.
The effect of prostacyclin infusion on markers of endothelial activation and damage in mechanically ventilated patients with SARS-CoV-2 infection.
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DOI：
10.1016/j.jcrc.2022.154010
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发表时间：
2022-06
影响因子：
3.7
通讯作者：
Johansson PI
中科院分区：
文献类型：
--
作者：
Vigstedt M;Søe-Jensen P;Bestle MH;Clausen NE;Kristiansen KT;Lange T;Stensballe J;Perner A;Johansson PI
在一项初步研究中，我们发现接受前列环素治疗的COVID-19机械通气患者的平均每日序贯器官衰竭评估评分与安慰剂相比显著降低。我们在这里研究对内皮活化和损伤的生物标志物的影响。在确诊SARS-CoV-2感染、机械通气、可溶性血栓调节蛋白（sTM）血浆水平>4 ng/mL的成人患者中进行的随机对照试验的事后研究。患者接受前列环素输注（1 ng/kg/min）或安慰剂。在基线和24 h采集血样。80例患者随机分组（前列环素组41例，安慰剂组39例）。24小时syndecan-1血浆水平的中位数变化为-3.95前列环素组（IQR：−21.1至2.71）ng/mL vs. 3.06（IQR：−8.73至20.5）ng/mL，安慰剂组（中位数差异：-7.01 [95% CI：-22.3至-0.231] ng/mL，相当于-3%[95% CI：-11%至0%]，p = 0.04）。两组之间sTM、PECAM-1、p-选择素和CD 40 L的血浆水平变化无显著差异。与安慰剂相比，前列环素输注导致24 h时内皮糖萼脱落（多配体蛋白聚糖-1）的可测量减少，表明对内皮具有保护作用，这可能与观察到的器官衰竭减少有关。
In a pilot study, we found a significant reduction in mean daily sequential organ failure assessment score in mechanically ventilated patients with COVID-19 who received prostacyclin, compared to placebo. We here investigate the effect on biomarkers of endothelial activation and damage. Post-hoc study of a randomized controlled trial in adult patients with confirmed SARS-CoV-2 infection, mechanically ventilated, with soluble thrombomodulin (sTM) plasma levels >4 ng/mL. Patients received prostacyclin infusion (1 ng/kg/min) or placebo. Blood samples were collected at baseline and 24 h. Eighty patients were randomized (41 prostacyclin, 39 placebo). The median changes in syndecan-1 plasma levels at 24 h were −3.95 (IQR: −21.1 to 2.71) ng/mL in the prostacyclin group vs. 3.06 (IQR: −8.73 to 20.5) ng/mL in the placebo group (difference of the medians: -7.01 [95% CI: −22.3 to −0.231] ng/mL, corresponding to −3% [95% CI: −11% to 0%], p = 0.04). Changes in plasma levels of sTM, PECAM-1, p-selectin, and CD40L did not differ significantly between groups. Prostacyclin infusion, compared to placebo, resulted in a measurable decrease in endothelial glycocalyx shedding (syndecan-1) at 24 h, suggesting a protective effect on the endothelium, which may be related to the observed reduction in organ failure.
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期刊：
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影响因子：
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