Nakamura Tsukasa, Kawagoe Yasuhiro, Matsuda Takaharu, Ebihara Isao, Koide Hikaru
Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
Blood Purif. 2003;21(4-5):282-6. doi: 10.1159/000072546.
Septic encephalopathy is a common term denoting the signs of progressing central nervous system dysfunction in septic patients. Metabolic alterations including amino acid imbalance are involved in the pathogenesis of septic encephalopathy. The aim of the present study was to determine whether the ratio of branched-chain amino acids to aromatic amino acids is altered in patients with septic encephalopathy and whether polymyxin B-immobilized fiber (PMX-F) hemoperfusion affects this balance.
16 septic patients with encephalopathy, 10 septic patients without encephalopathy, and 20 healthy controls were included in this study. Sepsis was diagnosed according to the ACCP/SCCM Consensus Conference criteria. Plasma endotoxin levels, interleukin-6 (IL-6) levels, and amino acid ratios were measured before and after PMX-F treatment.
Within 12 h of the onset of septic encephalopathy, plasma endotoxin and IL-6 levels were increased significantly in septic patients with encephalopathy in comparison to those in septic patients without encephalopathy (endotoxin, p < 0.05; IL-6, p < 0.01) and those in healthy controls (endotoxin; p < 0.001; IL-6, p < 0.001). The ratio of branched-chain amino acids to aromatic amino acids in septic patients with encephalopathy was decreased in comparison to the ratio in septic patients without encephalopathy (p < 0.05) and that in healthy controls (p < 0.01). PMX-F treatment reduced plasma endotoxin (p < 0.01) and IL-6 levels (p < 0.01) and increased the ratio of branched-chain amino acids to aromatic amino acids (p < 0.01).
The amino acid imbalance in patients with septic encephalopathy may be a marker for the severity of the septic syndrome, and PMX-F hemoperfusion is effective in ameliorating the increased plasma endotoxin and IL-6 levels and the amino acid imbalance in these patients.
脓毒症性脑病是一个常用术语，指脓毒症患者中枢神经系统功能进行性障碍的体征。包括氨基酸失衡在内的代谢改变参与了脓毒症性脑病的发病机制。本研究的目的是确定脓毒症性脑病患者支链氨基酸与芳香族氨基酸的比例是否发生改变，以及多粘菌素B固定纤维（PMX-F）血液灌流是否会影响这种平衡。
本研究纳入了16例患有脑病的脓毒症患者、10例无脑病的脓毒症患者和20名健康对照者。根据美国胸科医师学会/危重病医学会共识会议标准诊断脓毒症。在PMX-F治疗前后测量血浆内毒素水平、白细胞介素-6（IL-6）水平和氨基酸比例。
在脓毒症性脑病发病后12小时内，与无脑病的脓毒症患者相比（内毒素，p<0.05；IL-6，p<0.01）以及与健康对照者相比（内毒素；p<0.001；IL-6，p<0.001），患有脑病的脓毒症患者血浆内毒素和IL-6水平显著升高。与无脑病的脓毒症患者的比例相比（p<0.05）以及与健康对照者的比例相比（p<0.01），患有脑病的脓毒症患者支链氨基酸与芳香族氨基酸的比例降低。PMX-F治疗降低了血浆内毒素（p<0.01）和IL-6水平（p<0.01），并提高了支链氨基酸与芳香族氨基酸的比例（p<0.01）。
脓毒症性脑病患者的氨基酸失衡可能是脓毒症综合征严重程度的一个指标，并且PMX-F血液灌流可有效改善这些患者血浆内毒素和IL-6水平升高以及氨基酸失衡的情况。
