Intensive Care Unit, Jikei University Hospital, Tokyo, Japan.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Curr Opin Crit Care. 2022 Aug 1;28(4):374-380. doi: 10.1097/MCC.0000000000000951. Epub 2022 Jul 5.
Several studies have recently explored the effects of intravenous vitamin C in sepsis. We aimed to summarize their findings to provide perspectives for future research.
Sepsis trials examined 6 g/day of intravenous vitamin C with or without the thiamine and/or hydrocortisone compared with placebo or hydrocortisone. Network meta-analysis reported that intravenous vitamin C, thiamine, hydrocortisone, or combinations of these drugs was not proven to reduce long-term mortality. However, the component network meta-analysis suggested an association of high-dose (>6 g/day) and very-high dose vitamin C (>12 g/day) and decreased mortality but with low certainty. The preclinical investigations have, however, advanced to much higher doses of intravenous vitamin C therapy since a scoping review on harm reported that mega-doses of intravenous vitamin C (50-100 g/day) had been administered without any conclusive adverse effects. In a Gram-negative sheep model, renal tissue hypoperfusion was reversed, followed by improvements in kidney function when a mega-dose of vitamin C (150 g/day equivalent) was administered.
The effect of intravenous vitamin C in critically ill patients has yet to be determined and might be dose-dependent. Clinical studies of very high or mega doses of vitamin C are justified by preclinical data.
最近有几项研究探讨了静脉用维生素 C 在脓毒症中的作用。我们旨在总结这些研究结果，为未来的研究提供思路。
脓毒症试验比较了静脉用维生素 C 6g/天加或不加硫胺素和/或氢化可的松与安慰剂或氢化可的松的疗效。网络荟萃分析报告称，静脉用维生素 C、硫胺素、氢化可的松或这些药物的组合并不能证明能降低长期死亡率。然而，成分网络荟萃分析表明，高剂量（＞6g/天）和超高剂量（＞12g/天）维生素 C 与死亡率降低有关，但证据质量较低。然而，由于一项关于危害的范围综述报告称，已经给予超大剂量（50-100g/天）的静脉用维生素 C 而没有任何明确的不良影响，因此，关于静脉用维生素 C 治疗的临床前研究已经推进到更高的剂量。在革兰氏阴性绵羊模型中，给予超大剂量维生素 C（相当于 150g/天）可逆转肾组织低灌注，随后肾功能改善。
静脉用维生素 C 在危重症患者中的作用尚未确定，可能与剂量有关。根据临床前数据，有理由对非常高剂量或超大剂量的维生素 C 进行临床研究。
