Kern H, Wittich R, Rohr U, Kox W J, Spies C D
Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Mitte, Humboldt University of Berlin, Germany.
Chest. 2001 Mar;119(3):874-83. doi: 10.1378/chest.119.3.874.
Recently, it was proposed that soluble intercellular adhesion molecule (sICAM)-1 plasma levels may allow subgroup identification of patients at risk for cardiovascular complications during sepsis. However, the impact of preexisting coronary artery disease (CAD) on these results has not yet been tested. The aim of this study was to investigate whether plasma levels of adhesion molecules, nitric oxide, and cytokines differ between septic patients with or without preexisting CAD.
Prospective study.
Surgical ICU.
Forty-four septic patients, 24 of whom met the criteria of CAD.
Hemodynamic measurements were performed and blood samples were taken within 12 h after onset of sepsis (early sepsis) and again 72 h thereafter (late sepsis). Soluble adhesion molecules and cytokines were determined using commercially available enzyme-linked immunosorbent assay kits, cyclic guanosinomonophosphate (cGMP) by competitive radioimmunoassay, and nitrite/nitrate photometrically by Griess reaction.
In CAD patients, sICAM-1 (p < 0.02) was significantly elevated in early and late sepsis, whereas soluble endothelial-linked adhesion molecule (sE-selectin; p < 0.01) and cGMP (p < 0.03) were only increased in late sepsis. Oxygen consumption did not significantly differ between groups. Oxygen delivery and mixed venous oxygen saturation during early and late sepsis were significantly diminished and the oxygen extraction ratio significantly increased in the CAD group (p < 0.05).
Increased endothelial injury may be indicated by the elevated levels of sICAM-1, sE-selectin, and cGMP in septic patients with preexisting CAD. These parameters, however, failed to serve as predictors for unknown CAD or chances for survival in early sepsis.
最近有研究表明，可溶性细胞间黏附分子（sICAM）-1血浆水平可能有助于对脓毒症期间有心血管并发症风险的患者进行亚组识别。然而，既往冠状动脉疾病（CAD）对这些结果的影响尚未得到验证。本研究的目的是调查有或无既往CAD的脓毒症患者之间黏附分子、一氧化氮和细胞因子的血浆水平是否存在差异。
前瞻性研究。
外科重症监护病房。
44例脓毒症患者，其中24例符合CAD标准。
在脓毒症发作后12小时内（早期脓毒症）进行血流动力学测量并采集血样，此后72小时再次测量（晚期脓毒症）。使用市售酶联免疫吸附测定试剂盒测定可溶性黏附分子和细胞因子，通过竞争性放射免疫测定法测定环磷酸鸟苷（cGMP），通过格里斯反应光度法测定亚硝酸盐/硝酸盐。
在CAD患者中，sICAM-1（p<0.02）在早期和晚期脓毒症中均显著升高，而可溶性内皮连接黏附分子（sE-选择素；p<0.01）和cGMP（p<0.03）仅在晚期脓毒症中升高。两组之间的氧耗量无显著差异。CAD组在早期和晚期脓毒症期间的氧输送和混合静脉血氧饱和度显著降低，氧摄取率显著升高（p<0.05）。
既往有CAD的脓毒症患者中sICAM-1、sE-选择素和cGMP水平升高可能表明内皮损伤增加。然而，这些参数未能作为早期脓毒症中未知CAD的预测指标或生存机会的预测指标。
