Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
J Investig Med. 2021 Oct;69(7):1330-1338. doi: 10.1136/jim-2021-001837. Epub 2021 May 18.
Necrotizing soft-tissue infection (NSTI) is a rare, severe, and fast-progressing bacterial infection associated with a high risk of developing sepsis or septic shock. Increasing evidence indicates that oxidative stress is crucial in the development and progression of sepsis, but its role in NSTI specifically has not been investigated. Some patients with NSTI receive hyperbaric oxygen (HBO) treatment as the restoration of oxidative stress balance is considered an important mechanism of action, which HBO facilitates. However, a gap in knowledge exists regarding the effect of HBO treatment on oxidative stress in patients with NSTI. In the present observational study, we aimed to investigate HBO treatment effects on known markers of oxidative stress in patients with NSTI. We measured plasma myeloperoxidase (MPO), superoxide dismutase (SOD), heme oxygenase-1 (HO-1) and nitrite+nitrate in 80 patients with NSTI immediately before and after their first HBO treatment, and on the following day. We found that HBO treatment was associated with a significant increase in MPO and SOD by a median of 3.4 and 8.8 ng/mL, respectively. Moreover, we observed an HBO treatment-associated increase in HO-1 in patients presenting with septic shock (n=39) by a median of 301.3 pg/mL. All markers were significantly higher in patients presenting with septic shock compared to patients without shock, and all markers correlated with disease severity. High baseline SOD was associated with 90-day mortality. In conclusion, HBO treatment was associated with an increase in MPO and SOD in patients with NSTI, and oxidative stress was more pronounced in patients with septic shock.
坏死性软组织感染（NSTI）是一种罕见的、严重的、快速进展的细菌性感染，发生脓毒症或感染性休克的风险很高。越来越多的证据表明，氧化应激在脓毒症的发生和发展中至关重要，但它在 NSTI 中的作用尚未得到研究。一些 NSTI 患者接受高压氧（HBO）治疗，因为恢复氧化应激平衡被认为是其重要的作用机制，而 HBO 有助于这一过程。然而，关于 HBO 治疗对 NSTI 患者氧化应激的影响，目前还存在知识空白。在本观察性研究中，我们旨在研究 HBO 治疗对 NSTI 患者已知氧化应激标志物的影响。我们在 80 名 NSTI 患者首次 HBO 治疗前后以及次日测量了血浆髓过氧化物酶（MPO）、超氧化物歧化酶（SOD）、血红素加氧酶-1（HO-1）和亚硝酸盐+硝酸盐。我们发现，HBO 治疗与 MPO 和 SOD 中位数分别增加 3.4 和 8.8ng/ml 显著相关。此外，我们观察到在发生感染性休克的患者（n=39）中，HO-1 与 HBO 治疗相关，中位数增加 301.3pg/ml。与无休克的患者相比，休克患者的所有标志物均显著升高，所有标志物均与疾病严重程度相关。高基线 SOD 与 90 天死亡率相关。总之，HBO 治疗与 NSTI 患者的 MPO 和 SOD 增加有关，而在发生感染性休克的患者中氧化应激更为明显。
