Iba Toshiaki, Miyasho Taku
Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Crit Care. 2008;12(4):R86. doi: 10.1186/cc6943. Epub 2008 Jul 6.
Anticoagulant therapy attracts much attention for the treatment of severe sepsis since recent studies have revealed that some anticoagulants have the ability to regulate the inflammatory response. The purpose of this study was to examine whether danaparoid sodium (DA) is effective for the treatment of organ dysfunction in sepsis.
Sixty-four Wistar rats were intravenously injected with 5.0 mg/kg of lipopolysaccharide (LPS) and then divided into two groups: the DA group and the control group (n = 32 each). The DA group was injected intravenously with 400 U/kg of DA immediately after LPS injection, whereas the control group received saline. Blood samples were drawn at 1, 6, 12, and 24 hours after LPS injection, and organ damage markers and coagulation markers were measured. In the other series, 10 rats treated with LPS were divided into DA and control groups (n = 5 each). Blood samples were collected at 1, 3, and 6 hours after LPS injection and served for the cytokine measurements.
The elevation of the organ damage markers, such as alanine aminotransferase and lactate dehydrogenase, was significantly suppressed in the DA group. Coagulation markers, such as AT activity and fibrinogen levels, were maintained better in the DA group at 6 hours. The elevation of proinflammatory cytokines such as tumor necrosis factor-alpha, interleukin (IL)-1, and IL-6 was significantly suppressed in the DA group. On the other hand, there was no significant difference in anti-inflammatory cytokines such as IL-4 and IL-10.
DA preserves the organ dysfunction in LPS-challenged rats. Although the mechanism is not fully elucidated, not only the improvement of coagulation disorder but also the regulation of circulating levels of proinflammatory cytokines may play a role in the mechanism.
由于最近的研究表明一些抗凝剂具有调节炎症反应的能力,抗凝治疗在严重脓毒症的治疗中备受关注。本研究的目的是检验达那肝素钠(DA)对脓毒症器官功能障碍的治疗是否有效。
64只Wistar大鼠静脉注射5.0mg/kg脂多糖(LPS),然后分为两组:DA组和对照组(每组n = 32)。DA组在注射LPS后立即静脉注射400U/kg的DA,而对照组接受生理盐水。在注射LPS后1、6、12和24小时采集血样,检测器官损伤标志物和凝血标志物。在另一组实验中,10只接受LPS治疗的大鼠分为DA组和对照组(每组n = 5)。在注射LPS后1、3和6小时采集血样用于细胞因子检测。
DA组中,丙氨酸转氨酶和乳酸脱氢酶等器官损伤标志物的升高得到显著抑制。在6小时时,DA组的凝血标志物如抗凝血酶(AT)活性和纤维蛋白原水平维持得更好。DA组中肿瘤坏死因子-α、白细胞介素(IL)-1和IL-6等促炎细胞因子的升高得到显著抑制。另一方面,IL-4和IL-10等抗炎细胞因子没有显著差异。
DA可减轻LPS攻击大鼠的器官功能障碍。虽然其机制尚未完全阐明,但不仅凝血紊乱的改善,而且促炎细胞因子循环水平的调节可能在该机制中发挥作用。