急性血管阻塞性镰状细胞危象中的一氧化氮代谢物水平

Nitric oxide metabolite levels in acute vaso-occlusive sickle-cell crisis.

作者信息

Lopez B L, Barnett J, Ballas S K, Christopher T A, Davis-Moon L, Ma X

机构信息

Division of Emergency Medicine, Jefferson Medical College, Philadelphia, PA, USA.

出版信息

Acad Emerg Med. 1996 Dec;3(12):1098-103. doi: 10.1111/j.1553-2712.1996.tb03367.x.

DOI:10.1111/j.1553-2712.1996.tb03367.x

PMID:8959162

Abstract

OBJECTIVES

To measure nitric oxide (NO) metabolite levels in patients presenting to the ED in acute vaso-occlusive sickle-cell crisis (SCC), and 2) to determine whether a relationship exists between NO metabolite levels and pain.

METHODS

A prospective, observational study of patients with documented sickle-cell anemia (SCA), aged > or = 18 years, presenting in typical, acute SCC was conducted in an urban, university teaching hospital. Excluded were those with atypical pain or acute, coexistent disease (as evidenced by fever, tachycardia, tachypnea, or hypotension). Pain scores were measured by a 10-cm visual analog scale (VAS). Blood NO metabolite levels for SCC patients and control subjects (healthy volunteers, n = 9; SCA control subjects not in SCC, n = 10) were determined using an NO-specific chemiluminescence technique that measured plasma nitrite and nitrate, the stable end-products of NO. The acute SCC patients were divided into 3 groups, with the range for the SCC-normal (n = 5) group defined as within 2 SD of the healthy volunteer control patients. The SCC-low patients (n = 21) had NO metabolite levels below this range and the SCC-high (n = 21) patients had levels above this range.

RESULTS

The SCA and healthy volunteer control groups had similar NO metabolite levels (25.3 vs 22.6 mumol; p = 0.10). The 3 acute SCC groups had the following mean NO levels: 1) SCC-normal = 21.3 +/- 1.6 mumol; 2) SCC-low = 7.2 +/- 1.1 mumol; and 3) SCC-high = 43.7 +/- 3.5 mumol. The SCC-high NO-level group had significantly lower VAS pain scores when compared with the SCC-low and SCC-normal NO-level groups (6.52 +/- 1.85 cm vs 8.76 +/- 0.83 cm, and 8.62 +/- 1.29 cm, p = 0.02).

CONCLUSION

NO metabolite levels vary in SCC patients. Elevated levels are associated with lower pain scores, while lower levels are associated with higher pain scores, indicating that NO metabolites may potentially represent a marker for compensatory mechanisms in SCC tissue ischemia. Further work is needed to delineate the usefulness of NO metabolites in assessing the severity of SCC.

摘要

目的

1）测量因急性血管闭塞性镰状细胞危象（SCC）就诊于急诊科的患者体内一氧化氮（NO）代谢物水平；2）确定NO代谢物水平与疼痛之间是否存在关联。

方法

在一家城市大学教学医院对年龄≥18岁、有镰状细胞贫血（SCA）记录且表现为典型急性SCC的患者进行了一项前瞻性观察研究。排除那些有非典型疼痛或急性并存疾病（如发热、心动过速、呼吸急促或低血压所证明）的患者。疼痛评分采用10厘米视觉模拟量表（VAS）进行测量。使用一种测量血浆亚硝酸盐和硝酸盐（NO的稳定终产物）的NO特异性化学发光技术测定SCC患者和对照受试者（健康志愿者，n = 9；非SCC状态的SCA对照受试者，n = 10）的血液NO代谢物水平。急性SCC患者被分为3组，SCC正常组（n = 5）的范围定义为在健康志愿者对照患者的2个标准差范围内。SCC低水平组（n = 21）的NO代谢物水平低于此范围，SCC高水平组（n = 21）的水平高于此范围。

结果

SCA组和健康志愿者对照组的NO代谢物水平相似（25.3对22.6 μmol；p = 0.10）。3个急性SCC组的平均NO水平如下：1）SCC正常组 = 21.3 ± 1.6 μmol；2）SCC低水平组 = 7.2 ± 1.1 μmol；3）SCC高水平组 = 43.7 ± 3.5 μmol。与SCC低水平组和SCC正常水平组相比，SCC高水平组的VAS疼痛评分显著更低（6.52 ± 1.85厘米对8.76 ± 0.83厘米和8.62 ± 1.29厘米，p = 0.02）。