危重症患者氧化损伤、抗氧化状态及临床结局的标志物

Markers of oxidative damage, antioxidant status and clinical outcome in critically ill patients.

作者信息

Mishra Vinita, Baines Malcolm, Wenstone Richard, Shenkin Alan

机构信息

Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Liverpool L69 3GA, UK.

出版信息

Ann Clin Biochem. 2005 Jul;42(Pt 4):269-76. doi: 10.1258/0004563054255461.

DOI:10.1258/0004563054255461

PMID:15989727

Abstract

BACKGROUND

Oxidative stress is a consequence of critical illness, and may have an impact on survival. We studied markers of oxidative damage and antioxidant (AO) protection and compared them with clinical scores and outcome.

METHODS

Blood sampling and clinical scoring was carried out on 60 consecutively admitted intensive therapy unit (ITU) patients within 24 h of admission and then every three days of ITU stay. The patients included 30 surgical and 30 medical patients, of whom 46 survived their stay in ITU. Clinical scoring was by Acute Physiology and Chronic Health Evaluation (APACHE) II score, multiple organ dysfunction (MOD) score and sepsis rating. Oxidative damage was assessed by measurement of plasma malondialdehyde (MDA) and F2 isoprostanes (F2 IsoPs). AO protection was assessed by measurement of plasma total AO status, AO gap, ascorbic acid and the enzymes glutathione peroxidase and superoxide dismutase.

RESULTS

Both clinical markers, APACHE II and MOD, and oxidative damage markers MDA and F2 IsoPs were significantly higher in non-survivors (NS) than in survivors (S) at the time of admission. Median (interquartile ranges) were (APACHE II), 14[12--17] (S), 20.5[16.7--22.2] (NS),P<0.0001; (MOD), 3.0[2.0--5.0] (S), 8.0[4.7--9.2] (NS), P<0.0005; (MDA, mumol/L), 0.22[0.19--0.27] (S), 0.25[0.20--0.34] (NS), P=0.04 and (F2 IsoPs, pg/mL), 9.7[6.0--9.9] (S), 11.0[9.0--12.0] (NS), P=0.01. Oxidative damage markers reduced (improved) in the survivors but increased in the non-survivors. There was little difference between the groups in AO protection markers. There was a significant positive correlation between MOD and markers of oxidative damage at the time of admission (r=0.40, P=0.003, F2 IsoPs; r=0.28, P=0.035, MDA) and between the oxidative damage markers themselves (r=0.32, P=0.017).

CONCLUSION

Increased oxidative stress is associated with poor outcome in critically ill patients, and may be a prognostic indicator. Oxidative damage markers are more useful than AO protection markers in predicting outcome.

摘要

背景

氧化应激是危重病的一个后果，可能对生存率产生影响。我们研究了氧化损伤和抗氧化（AO）保护的标志物，并将它们与临床评分及预后进行比较。

方法

对60例连续入住重症监护病房（ITU）的患者在入院后24小时内进行血样采集和临床评分，此后在ITU住院期间每三天进行一次。患者包括30例外科患者和30例内科患者，其中46例在ITU住院期间存活。临床评分采用急性生理与慢性健康状况评估（APACHE）II评分、多器官功能障碍（MOD）评分和脓毒症分级。通过测量血浆丙二醛（MDA）和F2异前列腺素（F2 IsoPs）评估氧化损伤。通过测量血浆总AO状态、AO差距、抗坏血酸以及谷胱甘肽过氧化物酶和超氧化物歧化酶等酶来评估AO保护。

结果

入院时，非存活者（NS）的临床标志物APACHE II和MOD以及氧化损伤标志物MDA和F2 IsoPs均显著高于存活者（S）。中位数（四分位间距）分别为（APACHE II），14[12 - 17]（S），20.5[16.7 - 22.2]（NS），P<0.0001；（MOD），3.0[2.0 - 5.0]（S），8.0[4.7 - 9.2]（NS），P<0.0005；（MDA，μmol/L），0.22[0.19 - 0.27]（S），0.25[0.20 - 0.34]（NS），P = 0.04；（F2 IsoPs，pg/mL），9.7[6.0 - 9.9]（S），11.0[9.0 - 12.0]（NS），P = 0.01。氧化损伤标志物在存活者中降低（改善），而在非存活者中升高。两组在AO保护标志物方面差异不大。入院时MOD与氧化损伤标志物之间存在显著正相关（r = 0.40，P = 0.003，F2 IsoPs；r = 0.28，P = 0.035，MDA），氧化损伤标志物之间也存在正相关（r = 0.32，P = 0.017）。