Bouchama A, Hammami M M, Haq A, Jackson J, al-Sedairy S
Department of Medicine, King Faisai Specialist Hospital and Research Centre, Rlyadh, Saudi Arabia.
Crit Care Med. 1996 Jul;24(7):1173-8. doi: 10.1097/00003246-199607000-00018.
We treated the hypothesis that heatstroke is associated with endothelial cell activation/injury and examined the possibility that the markers of endothelial cell activation/injury may be associated with its severity and complications such as disseminated intravascular coagulation, lung injury, and renal dysfunction.
Prospective analyses.
Heatstroke Center in Makkah, Saudi Arabia.
Twenty-two adult patients with heatstroke.
The plasma concentration of endothelin, circulating intercellular adhesion molecule-1 (ICAM-1), and von Willebrand factor-antigen values were measured, respectively, by radioimmunoassay, enzyme-linked immunosorbent assay, and rocket electroimmunoassay, in heatstroke patients on admission (precooling) and after complete cooling (postcooling), and in ten normal control patients.
Precooling heatstroke patients (rectal temperature 40.9 +/- 1.1 [SD] degrees C) had increased circulating concentrations of endothelin, c-ICAM-1, and von Willebrand factor-antigen in 100%, 80%, and 77% of patients to 126.4 +/- 11.2 pmol/L, 523.1 +/- 154.4 ng/mL, and 3.85 +/- 2.3 U/mL, respectively (control values: 13.7 +/- 4.2 pmol/L [p < .001]; 247.4 +/- 68.2 ng/ml [p < .001]; and < 1.5 U/mL, respectively). There was a significant (r2 = .68, p < .01) correlation between circulating ICAM-1 and endothelin concentrations. Plasma endothelin concentration correlated negatively with temperature (r2 = .35, p < .05). Mean endothelin concentration was similar in patients with or without renal dysfunction, and mean von Willebrand factor-antigen concentration was similar in patients with or without lung injury or disseminated intravascular coagulation. There were no significant correlations between circulating ICAM-1, endothelin, or von Willebrand factor-antigen concentration and the Simplified Acute Physiology core. After cooling, mean circulating ICAM-1 and endothelin concentrations decreased significantly to 400 +/- 109 ng/mL and 93 +/- 38.5 pmol/L, respectively, whereas the mean von Willebrand factor-antigen concentration increased to 5.55 +/- 2.18 U/mL (p > .05).
Our findings of increased circulating concentrations of circulating ICAM-1, endothelin, and von Willebrand factor-antigen are consistent with the hypothesis that heatstroke is associated with endothelial cell activation/injury. Whether the endothelial cell activation/injury is implicated in the pathophysiology of this disorder merits further studies.
我们验证了中暑与内皮细胞激活/损伤相关的假说，并研究了内皮细胞激活/损伤标志物可能与其严重程度及诸如弥散性血管内凝血、肺损伤和肾功能不全等并发症相关的可能性。
前瞻性分析。
沙特阿拉伯麦加的中暑中心。
22例成年中暑患者。
分别采用放射免疫分析法、酶联免疫吸附测定法和火箭免疫电泳法，测定中暑患者入院时（预降温）和完全降温后（降温后）以及10例正常对照患者血浆中内皮素、循环细胞间黏附分子-1（ICAM-1）和血管性血友病因子抗原的值。
预降温的中暑患者（直肠温度40.9±1.1[标准差]℃）中，100%、80%和77%的患者循环内皮素、c-ICAM-1和血管性血友病因子抗原浓度升高，分别达到126.4±11.2 pmol/L、523.1±154.4 ng/mL和3.85±2.3 U/mL（对照值分别为：13.7±4.2 pmol/L[p<.001]；247.4±68.2 ng/ml[p<.001]；<1.5 U/mL）。循环ICAM-1与内皮素浓度之间存在显著相关性（r2=.68，p<.01）。血浆内皮素浓度与体温呈负相关（r2=.35，p<.05）。有或无肾功能不全患者的平均内皮素浓度相似，有或无肺损伤或弥散性血管内凝血患者的平均血管性血友病因子抗原浓度相似。循环ICAM-1、内皮素或血管性血友病因子抗原浓度与简化急性生理学核心指标之间无显著相关性。降温后，循环ICAM-1和内皮素的平均浓度显著下降，分别降至400±109 ng/mL和93±38.5 pmol/L，而平均血管性血友病因子抗原浓度升至5.55±2.18 U/mL（p>.05）。
我们发现循环ICAM-1、内皮素和血管性血友病因子抗原浓度升高，这与中暑与内皮细胞激活/损伤相关的假说一致。内皮细胞激活/损伤是否与该疾病病理生理学有关值得进一步研究。
