Metnitz P G, Bartens C, Fischer M, Fridrich P, Steltzer H, Druml W
Dept. of Anesthesia and General Intensive Care, Vienna General Hospital, University of Vienna, Austria.
Intensive Care Med. 1999 Feb;25(2):180-5. doi: 10.1007/s001340050813.
Reactive oxygen species (ROS) have been implicated in the pathophysiology of ARDS. We investigated the pattern of antioxidants in plasma and ROS production by neutrophils in patients with ARDS over 6 days.
Observational study. Blood samples were taken when the diagnosis was made (D0) and after 3 (D3) and 6 days (D6) during therapy.
Intensive care units at a University Hospital.
Eight patients with ARDS were investigated, 17 healthy volunteers served as controls.
Plasma levels of ascorbate, alpha-tocopherol, retinol, beta-carotene, selenium and lipid peroxidation products (MDA) were determined and the activities of the antioxidative enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione-peroxidase (GSH-PX) in erythrocytes were measured. In addition, ROS production (superoxide anion and hydrogen peroxide) in activated neutrophils was assessed. Plasma levels of alpha-tocopherol, ascorbate, beta-carotene and selenium were reduced from the onset of illness. MDA plasma levels were increased throughout the illness. ROS generation from neutrophils was normal on D0 and decreased to D6 in ARDS patients.
The antioxidative system is severely compromised in patients with ARDS. Plasma levels of alpha-tocopherol, ascorbate, beta-carotene and selenium are decreased. Elevated MDA levels provide further evidence of massive oxidative stress. The routine replacement of micronutrients according to recommended daily allowances was inadequate to compensate for the increased requirements.
活性氧（ROS）与急性呼吸窘迫综合征（ARDS）的病理生理学有关。我们研究了ARDS患者6天内血浆中抗氧化剂的模式以及中性粒细胞产生ROS的情况。
观察性研究。在确诊时（D0）以及治疗期间3天（D3）和6天（D6）后采集血样。
大学医院的重症监护病房。
对8例ARDS患者进行了研究，17名健康志愿者作为对照。
测定了血浆中抗坏血酸、α-生育酚、视黄醇、β-胡萝卜素、硒和脂质过氧化产物（MDA）的水平，并测量了红细胞中抗氧化酶过氧化氢酶（CAT）、超氧化物歧化酶（SOD）和谷胱甘肽过氧化物酶（GSH-PX）的活性。此外，还评估了活化中性粒细胞中ROS的产生（超氧阴离子和过氧化氢）。从疾病发作开始，血浆中α-生育酚、抗坏血酸、β-胡萝卜素和硒的水平就降低了。在整个疾病过程中，血浆MDA水平升高。ARDS患者D0时中性粒细胞产生的ROS正常，到D6时下降。
ARDS患者的抗氧化系统严重受损。血浆中α-生育酚、抗坏血酸、β-胡萝卜素和硒的水平降低。MDA水平升高进一步证明了大量氧化应激的存在。按照推荐的每日摄入量常规补充微量营养素不足以满足增加的需求。
