Staudinger T, Presterl E, Graninger W, Locker G J, Knapp S, Laczika K, Klappacher G, Stoiser B, Wagner A, Tesinsky P, Kordova H, Frass M
Department of Internal Medicine I, University of Vienna, Austria.
Intensive Care Med. 1996 Sep;22(9):888-93. doi: 10.1007/BF02044112.
To evaluate the influence of pentoxifylline (PTX), a phosphodiesterase inhibitor, on cytokines and inflammatory proteins in patients suffering from septic shock.
Prospective study comparing a therapy group to a matched control group.
Medical intensive care unit at a university hospital.
Twenty four patients fulfilling the criteria of septic shock were included in this study. Twelve patients received PTX (therapy group) and 12 patients matched for diagnosis, age and gender served as the control group.
Pentoxifylline at 1 mg/kg per hour over 24 h in the therapy group.
Cytokine levels [tumor necrosis factor-alpha (TNF)], soluble TNF receptor [TNF-R], and interleukin-6 [IL-6] and inflammatory proteins [C-reactive protein, alpha-1-antitrypsin (AAT), fibronectin, and haptoglobin], as well as hemodynamic parameters and the APACHE III score were evaluated before initiation of therapy and 24 h-later. After 24 h, TNF levels were significantly lower in the therapy group (p = 0.013), while IL-6 levels were significantly higher in the therapy group (p = 0.030). Within the 24 h TNF declined significantly in the therapy group (p = 0.006), while IL-6 showed a significant increase (p = 0.043). AAT and the APACHE III score tended to differ significantly after 24 h between the groups [AAT levels higher in the therapy group (p = 0.05), APACHE III score lower (p = 0.05)]. In the therapy group, the systemic vascular resistance index was significantly higher after 24 h (p = 0.0026) whereas the cardiac index declined (p = 0.035).
PTX does influence TNF levels in septic shock patients. Nevertheless, inhibiting a single mediator in severe septic shock cannot stop the inflammatory overreaction.
评估磷酸二酯酶抑制剂己酮可可碱（PTX）对感染性休克患者细胞因子和炎症蛋白的影响。
将治疗组与匹配的对照组进行比较的前瞻性研究。
大学医院的医学重症监护病房。
本研究纳入了24例符合感染性休克标准的患者。12例患者接受PTX治疗（治疗组），另外12例在诊断、年龄和性别上与之匹配的患者作为对照组。
治疗组患者在24小时内按每小时1毫克/千克的剂量静脉输注己酮可可碱。
在治疗开始前及24小时后，评估细胞因子水平[肿瘤坏死因子-α（TNF）]、可溶性TNF受体[TNF-R]、白细胞介素-6[IL-6]以及炎症蛋白[C反应蛋白、α1抗胰蛋白酶（AAT）、纤连蛋白和触珠蛋白]，同时评估血流动力学参数和急性生理与慢性健康状况评分系统III（APACHE III）评分。24小时后，治疗组的TNF水平显著降低（p = 0.013），而IL-6水平显著升高（p = 0.030）。在24小时内，治疗组的TNF显著下降（p = 0.006），而IL-6显著升高（p = 0.043）。24小时后，两组之间AAT和APACHE III评分存在显著差异趋势[治疗组AAT水平较高（p = 0.05），APACHE III评分较低（p = 0.05）]。在治疗组中，24小时后全身血管阻力指数显著升高（p = 0.0026），而心脏指数下降（p = 0.035）。
PTX确实会影响感染性休克患者的TNF水平。然而，在严重感染性休克中抑制单一介质并不能阻止炎症反应过度。
