Wiedermann Christian J, Joannidis Michael
Department of Internal Medicine, Central Hospital of Bolzano, Lorenz-Böhler-Street 5, 39100, Bolzano, Italy.
Division of Emergency and Intensive Care Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria.
Intensive Care Med. 2014 Feb;40(2):160-170. doi: 10.1007/s00134-013-3156-9. Epub 2013 Nov 21.
To systematically review clinical and preclinical data on hydroxyethyl starch (HES) tissue storage.
MEDLINE (PubMed) was searched and abstracts were screened using defined criteria to identify articles containing original data on HES tissue accumulation.
Forty-eight studies were included: 37 human studies with a total of 635 patients and 11 animal studies. The most frequent indication for fluid infusion was surgery accounting for 282 patients (45.9%). HES localization in skin was shown by 17 studies, in kidney by 12, in liver by 8, and in bone marrow by 5. Additional sites of HES deposition were lymph nodes, spleen, lung, pancreas, intestine, muscle, trophoblast, and placental stroma. Among major organs the highest measured tissue concentration of HES was in the kidney. HES uptake into intracellular vacuoles was observed by 30 min after infusion. Storage was cumulative, increasing in proportion to dose, although in 15% of patients storage and associated symptoms were demonstrated at the lowest cumulative doses (0.4 g kg(-1)). Some HES deposits were extremely long-lasting, persisting for 8 years or more in skin and 10 years in kidney. Pruritus associated with HES storage was described in 17 studies and renal dysfunction in ten studies. In one included randomized trial, HES infusion produced osmotic nephrosis-like lesions indicative of HES storage (p = 0.01) and also increased the need for renal replacement therapy (odds ratio, 9.50; 95% confidence interval, 1.09-82.7; p = 0.02). The tissue distribution of HES was generally similar in animals and humans.
Tissue storage of HES is widespread, rapid, cumulative, frequently long-lasting, and potentially harmful.
系统回顾羟乙基淀粉（HES）组织储存的临床和临床前数据。
检索MEDLINE（PubMed），并使用既定标准筛选摘要，以识别包含HES组织蓄积原始数据的文章。
纳入48项研究：37项人体研究，共635例患者，11项动物研究。输液最常见的适应证是手术，占282例患者（45.9%）。17项研究显示HES定位于皮肤，12项定位于肾脏，8项定位于肝脏，5项定位于骨髓。HES沉积的其他部位有淋巴结、脾脏、肺、胰腺、肠道、肌肉、滋养层和胎盘基质。在主要器官中，测得的HES组织浓度最高的是肾脏。输液后30分钟观察到HES摄取进入细胞内空泡。储存是累积性的，与剂量成比例增加，尽管在15%的患者中，在最低累积剂量（0.4 g·kg⁻¹）时就出现了储存及相关症状。一些HES沉积物持续时间极长，在皮肤中持续8年或更长时间，在肾脏中持续10年。17项研究描述了与HES储存相关的瘙痒，10项研究描述了肾功能障碍。在一项纳入的随机试验中，HES输注产生了提示HES储存的渗透性肾病样病变（p = 0.01），并且还增加了肾脏替代治疗的需求（优势比，9.50；95%置信区间，1.09 - 82.7；p = 0.02）。HES在动物和人类中的组织分布总体相似。
HES的组织储存广泛、迅速、累积、通常持久且可能有害。
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