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维生素C:脓毒症期间一种必需的“应激激素”。

Vitamin C: an essential "stress hormone" during sepsis.

作者信息

Marik Paul E

机构信息

Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.

出版信息

J Thorac Dis. 2020 Feb;12(Suppl 1):S84-S88. doi: 10.21037/jtd.2019.12.64.

DOI:10.21037/jtd.2019.12.64
PMID:32148930
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7024758/
Abstract

The stress response is a preserved evolutionary response that functions to enhance the survival of the species. In mammals, the stress response is characterized by activation of the HPA axis and sympathoadrenal system (SAS) as well as the increased synthesis and secretion of vitamin C. Cortisol, catecholamines, and vitamin C act synergistically to increase hemodynamic reserve, maintain immune function and protect the host against excessive oxidant injury. Humans (and anthropoid apes) have lost the ability to synthesize vitamin C and therefore have an impaired stress response. The inability to produce vitamin C has serious implications in septic humans. Treatment with vitamin C appears to restore the stress response and improve the survival of stressed humans.

摘要

应激反应是一种保留下来的进化反应,其作用是提高物种的生存能力。在哺乳动物中,应激反应的特征是下丘脑-垂体-肾上腺(HPA)轴和交感-肾上腺系统(SAS)的激活以及维生素C合成和分泌的增加。皮质醇、儿茶酚胺和维生素C协同作用,以增加血流动力学储备、维持免疫功能并保护宿主免受过度的氧化损伤。人类(以及类人猿)已经失去了合成维生素C的能力,因此应激反应受损。无法产生维生素C对感染性休克患者有严重影响。用维生素C治疗似乎可以恢复应激反应并提高应激状态下人类的生存率。

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本文引用的文献

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Wide Interest in a Vitamin C Drug Cocktail for Sepsis Despite Lagging Evidence.
JAMA. 2019 Jul 23;322(4):291-293. doi: 10.1001/jama.2019.7936.
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Vitamin C, Hydrocortisone and Thiamine in Patients with Septic Shock (VITAMINS) trial: study protocol and statistical analysis plan.脓毒性休克患者维生素C、氢化可的松和硫胺素(VITAMINS)试验:研究方案与统计分析计划
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Safety of vitamin C in sepsis: a neglected topic.维生素 C 在脓毒症中的安全性:一个被忽视的话题。
Curr Opin Crit Care. 2019 Aug;25(4):329-333. doi: 10.1097/MCC.0000000000000622.
4
The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) Protocol: a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial.败血症患者中维生素 C、硫胺素和类固醇(VICTAS)方案:一项前瞻性、多中心、双盲、适应性样本量、随机、安慰剂对照的临床试验。
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The adrenal-vitamin C axis: from fish to guinea pigs and primates.肾上腺-维生素C轴:从鱼类到豚鼠和灵长类动物
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