Shpektor Alexander
Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia.
Acute Card Care. 2010 Dec;12(4):115-8. doi: 10.3109/17482941.2010.523705.
Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (MI) and we badly need new approaches in its treatment. It has been demonstrated that a number of inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α, CRP, soluble adhesion molecules, complement system etc) are elevated in acute MI complicated by CS. Baseline levels of pro- inflammatory cytokines have predictive value for the development of CS and subsequent mortality. The deleterious effects of pro- inflammatory cytokines may be due to excessive nitric oxide production by enzyme named NOS. However in multicenter randomized TRIUMPH study non-selective NOS inhibition was ineffective in the treatment of cardiogenic shock. A challenging subject of future studies will be treatment of CS with specific inhibitors of inducible isoform of NOS. Considering the results of treatment of patients with septic shock it would be reasonable to study the effects of small doses of corticosteroids and hemofiltration in patients with CS and signs of SIRS.
心源性休克（CS）是急性心肌梗死（MI）患者死亡的主要原因，我们急需新的治疗方法。已证实，在并发CS的急性MI中，多种炎性细胞因子（IL-1β、IL-6、IL-8、TNF-α、CRP、可溶性黏附分子、补体系统等）水平升高。促炎细胞因子的基线水平对CS的发生及后续死亡率具有预测价值。促炎细胞因子的有害作用可能归因于一种名为NOS的酶产生过量一氧化氮。然而，在多中心随机TRIUMPH研究中，非选择性NOS抑制在治疗心源性休克方面无效。未来研究的一个具有挑战性的课题将是使用诱导型NOS亚型特异性抑制剂治疗CS。考虑到感染性休克患者的治疗结果，研究小剂量皮质类固醇和血液滤过对有CS及全身炎症反应综合征（SIRS）体征患者的影响是合理的。
