Ebihara Itaru, Hirayama Kouichi, Nagai Miho, Kakita Tomoko, Sakai Kentaro, Tajima Reiko, Sato Chihiro, Kurosawa Hiromi, Togashi Amane, Okada Akiko, Usui Joichi, Yamagata Kunihiro, Kobayashi Masaki
Department of Nephrology, Mito Saiseikai General Hospital, Mito, Japan.
Ther Apher Dial. 2011 Aug;15(4):349-54. doi: 10.1111/j.1744-9987.2011.00963.x.
Acute lung injury (ALI) in sepsis is characterized by an increase in microvascular permeability, resulting in pulmonary edema. Several studies have suggested that angiopoietin-1 and -2 play a contributory role in the pathogenesis of ALI. Polymyxin B-immobilized fiber column hemoperfusion is effective for sepsis-induced ALI. We investigated the angiopoietin levels before and after direct hemoperfusion with polymyxin B-immobilized fiber column (PMX) therapy. Enzyme-linked immunoassay was used to measure the serum angiopoietin-1 and -2 levels in 25 patients with septic shock treated with PMX. Eleven of the 25 patients were diagnosed with ALI. There was a significant positive correlation between the angiopoietin-1 level and the PaO(2) /FiO(2) ratio, but there was a significant inverse correlation between the angiopoietin-2 level and the PaO(2) /FiO(2) ratio. The mean angiopoietin-1 level before PMX therapy in the ALI group was significantly lower and the mean angiopoietin-2 level was significantly higher than in the non-ALI group. The mean angiopoietin-1 level of the ALI patients in response to PMX therapy was increased during PMX therapy, but that of the non-ALI patients with newly occurring ALI showed a decreased angiopoietin-1 level. On the other hand, the mean angiopoietin-2 level of the responders was decreased during PMX therapy, but that of patients with newly occurring ALI showed an increased angiopoietin-2 level. This result suggested that each angiopoietin-1 and -2 level may play a role in the pathogenesis of ALI and that PMX therapy ameliorates the angiopoietin balance in patients with ALI in sepsis.
脓毒症中的急性肺损伤（ALI）的特征是微血管通透性增加，导致肺水肿。多项研究表明血管生成素-1和-2在ALI的发病机制中起作用。多黏菌素B固定纤维柱血液灌流对脓毒症诱导的ALI有效。我们研究了多黏菌素B固定纤维柱（PMX）治疗直接血液灌流前后的血管生成素水平。采用酶联免疫吸附测定法测量25例接受PMX治疗的感染性休克患者血清血管生成素-1和-2水平。25例患者中有11例被诊断为ALI。血管生成素-1水平与PaO(2)/FiO(2)比值呈显著正相关，但血管生成素-2水平与PaO(2)/FiO(2)比值呈显著负相关。ALI组PMX治疗前血管生成素-1平均水平显著低于非ALI组，血管生成素-2平均水平显著高于非ALI组。ALI患者对PMX治疗有反应者在PMX治疗期间血管生成素-1水平升高，但新发ALI的非ALI患者血管生成素-1水平降低。另一方面，有反应者的血管生成素-2平均水平在PMX治疗期间降低，但新发ALI患者的血管生成素-2水平升高。该结果表明血管生成素-1和-2各自的水平可能在ALI的发病机制中起作用，且PMX治疗可改善脓毒症ALI患者的血管生成素平衡。
