Ebihara Itaru, Hirayama Kouichi, Nagai Kei, Kakita Tomoko, Miyamoto Yasunori, Nagai Miho, Ogawa Yujiro, Fujita Shogo, Shimohata Homare, Kai Hirayasu, Usui Joichi, Yamagata Kunihiro, Kobayashi Masaki
Department of Nephrology, Mito Saiseikai General Hospital, Mito, Ibaraki, Japan.
Ther Apher Dial. 2009 Dec;13(6):520-7. doi: 10.1111/j.1744-9987.2009.00777.x.
Capillary permeability is a tightly regulated feature of microcirculation in all organ beds; however, in sepsis this feature is fundamentally altered. We previously reported elevated levels of vascular endothelial growth factor and its receptor (fms-like tyrosine kinase-1) in patients with septic shock, then investigated two kinds of angiopoietins in those patients. An enzyme-linked immunoassay was used to measure serum angiopoietin-1 and -2 levels in 12 patients with septic shock who were treated by direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX). The angiopoietin-1 level was lower in patients with septic shock (7.01 +/- 10.08 ng/mL) than in controls (28.24 +/- 11.61 ng/mL, P < 0.001), but the angiopoietin-2 level was higher in septic shock patients (40.83 +/- 30.13 ng/mL vs. 2.47 +/- 1.78 ng/mL, P < 0.001). Between seven survivors and five non-survivors there was no significant difference in angiopoietin-1 levels before DHP-PMX therapy. During DHP-PMX therapy, however, the angiopoietin-2 level was significantly decreased in survivors (31.52 +/- 26.15 ng/mL vs. 17.32 +/- 22.46 ng/mL, P = 0.035). Moreover, at the end of the therapy, the angiopoietin-1 level was significantly lower in non-survivors (1.14 +/- 1.30 ng/mL vs. 10.43 +/- 13.56 ng/mL, P = 0.042), but the angiopoietin-2 level in non-survivors was significantly higher (70.79 +/- 40.47 ng/mL vs. 17.32 +/- 22.46 ng/mL, P = 0.019). The angiopoietin-2 level may be associated with vascular permeability in septic patients, and angiopoietins may be suitable markers of disease severity and mortality.
毛细血管通透性是所有器官床微循环中受到严格调控的一个特征；然而，在脓毒症中这一特征会发生根本性改变。我们之前报道过脓毒性休克患者血管内皮生长因子及其受体（fms样酪氨酸激酶-1）水平升高，随后对这些患者的两种血管生成素进行了研究。采用酶联免疫吸附测定法测量了12例接受多黏菌素B固定纤维柱直接血液灌流（DHP-PMX）治疗的脓毒性休克患者血清血管生成素-1和-2水平。脓毒性休克患者的血管生成素-1水平（7.01±10.08 ng/mL）低于对照组（28.24±11.61 ng/mL，P<0.001），但脓毒性休克患者的血管生成素-2水平更高（4与2.47±1.78 ng/mL相比，0.83±30.13 ng/mL，P<0.001）。在DHP-PMX治疗前，7名幸存者和5名非幸存者的血管生成素-1水平无显著差异。然而，在DHP-PMX治疗期间，幸存者的血管生成素-2水平显著降低（31.52±26.15 ng/mL与17.32±22.46 ng/mL相比，P = 0.035）。此外，在治疗结束时，非幸存者的血管生成素-1水平显著更低（1.14±1.30 ng/mL与10.43±13.56 ng/mL相比，P = 0.042），但非幸存者的血管生成素-2水平显著更高（70.79±40.47 ng/mL与17.32±22.46 ng/mL相比，P = 0.019）。血管生成素-2水平可能与脓毒症患者的血管通透性相关，血管生成素可能是疾病严重程度和死亡率的合适标志物。
