Endogenous glycosides in critically ill patients
Endogenous glycosides in critically ill patients
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DOI：
10.1097/01.ccm.0000059721.57219.c3
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发表时间：
2003-05-01
影响因子：
8.8
通讯作者：
Walter, M
中科院分区：
文献类型：
--
作者：
Berendes, E;Cullen, P;Walter, M
目的：确定危重病患者表现内源性洋地黄样免疫反应物质(DLIS)的发生率，并研究这些激素与常规实验室变量、基础疾病、心肌功能、血流动力学状态、疾病严重性、全身炎症和死亡率的关系。设计：连续401例未接受心脏苷类药物治疗的危重病患者的血清，分析DLIS(洋地黄和地高辛，TDX；雅培诊断，伊利诺伊州北芝加哥)和内源性哇巴因。测定了62名健康志愿者内源性哇巴因的正常值。检测促炎和抗炎介质(L-选择素、肿瘤坏死因子-α、白介素1-β、白介素2、白介素6、白介素10)、C反应蛋白、血清淀粉样蛋白A，以及患者的急性生理学和慢性健康评估II和GORIS评分。在一组使用肺动脉导管的患者(n=95)中，我们测定了心输出量、肺动脉阻断压、体循环和肺血管阻力、左心室每搏输出量以及右和左每搏做功。对象：连续401例危重患者的血清。干预：采血。测量和主要结果：在接受检测的401例患者中，343例DLIS浓度(DLIS阴性)，58例(14.5%)地高辛(n=18)或洋地黄毒(n=34)浓度阳性(DLIS阳性)或两项检测均阳性(n=6)。DLIS阳性患者的平均内源性哇巴因浓度(3.59+/-1.43nmol/L)和阴性患者(1.34+/-0.81nmol/L)的平均内源性哇巴因浓度分别是对照组(0.38+/-0.31nmol/L)的3倍。DLIS和哇巴因浓度与急性生理学和慢性健康评估II和Goris评分密切相关，并与转氨酶、胆红素、醛固酮、皮质醇、血清肌酐、部分钠排泄、促炎介质、C反应蛋白和血清淀粉样蛋白A浓度升高相关(P<或等于.009)。DLIS阳性和DLIS阴性患者的住院死亡率分别为12%和3.2%，哇巴因浓度高于和低于2nmol/L的患者的住院死亡率分别为38.6%和0.6%。23例DLIS阳性患者经肺动脉插管后，心输出量、每搏输出量和左心室每搏做功减少，肺动脉阻断压和中心静脉压升高(P<0.05)。
Objective: To determine the incidence of critically ill patients displaying endogenous digitalis-like-immunoreactive substances (DLIS) and to examine the relationship of these hormones to routine laboratory variables, the underlying disease, myocardial function, hemodynamic status, severity of illness, systemic inflammation, and mortality rate.Design: Sera of 401 consecutive critically ill patients, not treated with cardiac glycosides, were analyzed for DLIS (digitoxin and digoxin, TDx; Abbott Diagnostics, North Chicago, IL) and endogenous ouabain. Normal values of endogenous ouabain were determined in 62 healthy volunteers. We measured pro- and anti-inflammatory mediators (L-selectin, tumor necrosis factor-alpha, interleukin-1beta, interleukin-2, interleukin-6, interleukin-10), C-reactive protein, and serum amyloid A protein as well as patients' Acute Physiology and Chronic Health Evaluation II and Goris scores. In a subgroup of patients with a pulmonary artery catheter (n = 95), we determined cardiac output, pulmonary artery occlusion pressure, systemic and pulmonary vascular resistance, left ventricular stroke volume, and right and left stroke work.Setting; Two surgical intensive care units of an university hospital.Subjects: Sera of 401 consecutive critically ill patients.Interventions: Blood sampling.Measurements and Main Results: Of the 401 patients tested, 343 had nonmeasurable DLIS concentrations (DLIS-negative), and 58 (14.5%) had positive digoxin (n = 18) or digitoxin (n = 34) concentrations (DLIS-positive) or were positive in both tests (n = 6). Mean endogenous ouabain concentrations were nine-fold increased in DLIS-positive (3.59 +/- 1.43 nmol/L) and three-fold increased in DLIS-negative (1.34 +/- .81 nmol/L) patients compared with controls (0.38 +/- 0.31 nmol/L). DLIS and ouabain concentrations closely correlated with the Acute Physiology and Chronic Health Evaluation II and Goris score and were associated with increased concentrations of transaminases, bilirubin, aldosterone, cortisol, serum creatinine, fractional sodium excretion, proinflammatory mediators, C-reactive protein, and serum amyloid A (pless than or equal to.009). The hospital mortality rates of DLIS-positive and DLIS-negative patients were 12% and 3.2%, respectively, and for patients with ouabain concentrations above and below 2 nmol/L 38.6% and 0.6%, respectively. In DLIS-positive patients with pulmonary artery catheter (n = 23), cardiac output, stroke volume, and left ventricular stroke work were decreased, and pulmonary artery occlusion pressure and central venous pressure were increased (p