EFFECTS OF INTESTINAL LAVAGE ON PATIENTS WITH SEPTIC MULTIPLE ORGAN FAILURE

肠灌洗对脓毒性多器官衰竭患者的影响

基本信息

批准号：
10671425
负责人：
NOGUCHI Takayuki
金额：
$ 1.86万
依托单位：
OITA MEDICAL UNIVERSITY
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1998
资助国家：
日本
起止时间：
1998 至 1999
项目状态：
已结题

项目摘要

1) In the present clinical study, the effects of plasma circulating inflammatory cytokines, plasma NOx levels and soluble Fas on acute lung injury and other organ failure were investigated in fifteen septic shock patients; seven patients were survivor and the other eight were nonsurvivor. The average PaO2/FIO2 ratio in nonsurvivors was lower than that in survivors (108±28 vs. 177±37; mean ±SD). Although plasma average Nox levels and sFas concentrations in nonsurvivors were much higher than those in survivors (Nox; 112.4±27.4 vs. 68.5 ±30.3 micro M/L, sFas; 3.3 ±1.2 vs. 1.4 ±0.5 U/ml), no correlation was found between PaO2/FIO2 ratio and Plasma Nox or sFas concentrations. In the present animal investigation, plasma inflammatory cytokines, plasma Nox levels, sFas and Fas expression in lung and liver tissues were investigated in cecal ligation and puncture (CLP) and liver ischemic reperfusion (I/R) rats. Although plasma levels of NOx in CLP rats were higher than those of I/R rats (33.5±2. … More 8 vs. 26.2±1.9 micro M/L), these values were considered minimal. Plasma sFas concentrations in CLP rats were lower than that in I/R rats. The expression of 66 kilodalton molecular weight Fas with Western blot in the lungs and the livers of CLP rats were less than that in I/R rats.The results of this clinical study and animal investigation suggest that a slightly elevated plasma Nox level has no effect on onset of acute lung injury and that apoptosis has only a slight effect on sepsis related lung injury in patients with sepsis but has some important effects on I/R related liver injury.2) Next, diamine oxidase (DAO) activity, IL-6, IL-8, IL-10 and sFas were measured in 14 septic patients with hyperbilirubinemia. The average total and direct bilirubin levels were 7.8±1.0mg/dl and 5.l±0.6mg/dl. The average IL-6, IL-8 and IL-10 were 146.8±35.3pg/ml, 120.6±14.4pg/ml and 197.5±43.5pg/ml, respectively. The average sFas level was 5.2±0.8ng/ml. Significant correlations were found in total birilubin value and sFas concentrations, IL-6/IL-10 and in DAO levels and sFas, IL-6/10 ratio.These results of this clinical study suggests that the increased plasma DAO level showed ischemic change in the gut and hyperbirirubinemia correlated to hypercytokinemia or apoptosis. But effects of gut lavage on hyperbirilubinemia could not be proven in this study, because only 4 patients with informed consent of this study were treated with hole gut lavage. Less

1）在本临床研究中，研究了15例化粪池休克患者的血浆循环炎性细胞因子，血浆NOX水平和固体FAS对急性肺损伤和其他器官衰竭的影响；七名患者是幸存者，另外八名患者是非生存者。平均PAO2/FIO2比率低于幸存者（108±28 vs. 177±37;平均值±SD）。尽管非生存率的血浆平均NOx水平和SFA浓度远高于生存率（NOX; 112.4±27.4 vs. 68.5±30.3 Micro M/L，SFA，SFA； 3.3±1.2 vs. 1.4±0.5 U/ml），但在PAO2/FIO2/FIO2/FIO2含量之间未发现相关性或无关。在目前的动物投资中，研究了血浆感染细胞因子，血浆NOX水平，SFA和FAS在肺和肝组织中的表达，在Cecal结扎和穿刺（CLP）和肝缺血再灌注（I/R）大鼠中研究了。尽管CLP大鼠NOx的血浆水平高于I/R大鼠的血浆水平（33.5±2。…更多8 vs. 26.2±1.9微米M/L），但这些值认为最小。 CLP大鼠中的血浆SFA浓度低于I/R大鼠的血浆浓度。肺中有蛋白质和CLP大鼠的生命的66千达顿分子量Fas的表达少于I/R大鼠的生命。这项临床研究和动物投资的结果表明，血浆NOX水平略有升高对急性肺损伤的发作略有影响，并且对SEPIS的影响略有影响，但在SEPIS中遇到了一定的损害，但在SEPIS中受到了一定的影响。接下来，在14例高胆红素血症患者中测量了二氨酸氧化酶（DAO）活性，IL-6，IL-8，IL-10和SFA。平均胆红素和直接胆红素水平为7.8±1.0mg/dl和5.l±0.6mg/dl。平均IL-6，IL-8和IL-10分别为146.8±35.3pg/ml，120.6±14.4pg/ml和197.5±43.5pg/ml。平均SFA水平为5.2±0.8ng/ml。在Birilubin的总价值和SFA浓度（IL-6/IL-10）以及DAO水平和SFAS和SFAS（IL-6/10）中发现了显着相关性。这项临床研究的这些结果表明，血浆DAO水平升高显示肠道缺血性变化，高脂蛋白血症与高胞症血症或凋亡相关。但是，在这项研究中无法证明肠道灌洗对高脂蛋白血症的影响，因为只有4例接受本研究知情同意的患者接受了孔肠道灌洗的治疗。较少的