Petroni Ricardo Costa, Biselli Paolo Jose Cesare, de Lima Thais Martins, Theobaldo Mariana Cardillo, Caldini Elia Tamaso, Pimentel Rosângela Nascimento, Barbeiro Hermes Vieira, Kubo Suely Ariga, Velasco Irineu Tadeu, Soriano Francisco Garcia
Emergency Medicine Department, Medical School, University of São Paulo, São Paulo, Brazil.
Faculdade de Medicina da USP, LIM-51, Av. Dr. Arnaldo, 455, 3 andar, sala 3189, Cerqueira César, 01246-903, São Paulo, SP, Brazil.
Inflammation. 2015 Dec;38(6):2026-35. doi: 10.1007/s10753-015-0183-4.
Acute respiratory distress syndrome (ARDS) is the most severe lung inflammatory manifestation and has no effective therapy nowadays. Sepsis is one of the main illnesses among ARDS causes. The use of fluid resuscitation is an important treatment for sepsis, but positive fluid balance may induce pulmonary injury. As an alternative, fluid resuscitation with hypertonic saline ((HS) NaCl 7.5%) has been described as a promising therapeutical agent in sepsis-induced ARDS by the diminished amount of fluid necessary. Thus, we evaluated the effect of hypertonic saline in the treatment of LPS-induced ARDS. We found that hypertonic saline (NaCl 7.5%) treatment in rat model of LPS-induced ARDS avoided pulmonary function worsening and inhibited type I collagen deposition. In addition, hypertonic saline prevented pulmonary injury by decreasing metalloproteinase 9 (MMP-9) activity in tissue. Focal adhesion kinase (FAK) activation was reduced in HS group as well as neutrophil infiltration, NOS2 expression and NO content. Our study shows that fluid resuscitation with hypertonic saline decreases the progression of LPS-induced ARDS due to inhibition of pulmonary remodeling that is observed when regular saline is used.
急性呼吸窘迫综合征(ARDS)是最严重的肺部炎症表现,目前尚无有效治疗方法。脓毒症是ARDS病因中的主要疾病之一。液体复苏是脓毒症的重要治疗方法,但液体正平衡可能会导致肺损伤。作为一种替代方法,用高渗盐水((HS)7.5%氯化钠)进行液体复苏已被描述为脓毒症诱导的ARDS中有前景的治疗药物,因为所需液体量减少。因此,我们评估了高渗盐水在治疗脂多糖诱导的ARDS中的作用。我们发现,在脂多糖诱导的ARDS大鼠模型中,高渗盐水(7.5%氯化钠)治疗可避免肺功能恶化,并抑制I型胶原蛋白沉积。此外,高渗盐水通过降低组织中金属蛋白酶9(MMP-9)的活性来预防肺损伤。高渗盐水组的粘着斑激酶(FAK)激活以及中性粒细胞浸润、NOS2表达和NO含量均降低。我们的研究表明,用高渗盐水进行液体复苏可减少脂多糖诱导的ARDS的进展,这是由于抑制了使用常规盐水时观察到的肺重塑。