Douzinas E E, Tsidemiadou P D, Pitaridis M T, Andrianakis I, Bobota-Chloraki A, Katsouyanni K, Sfyras D, Malagari K, Roussos C
Critical Care Department, Athens University School of Medicine, Greece.
Am J Respir Crit Care Med. 1997 Jan;155(1):53-9. doi: 10.1164/ajrccm.155.1.9001289.
In order to explore whether an organ-specific pattern in cytokine and lactate concentrations exists in patients with multiple organ failure (MOF), we measured the cytokines interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor-alpha (TNF-alpha), and lactate in blood taken from the hepatic vein, pulmonary capillaries, and peripheral veins of 10 patients with MOF with hepatic involvement (MOF-HI), eight patients with MOF and adult respiratory distress syndrome (MOF-ARDS), and five head-injured patients (controls). Ten additional patients participated in a study of arteriovenous pulmonary concentration gradients of these substances. For statistical analysis, nonparametric tests and analysis of variance (ANOVA) were used. The regional concentrations of these substances exhibited a different pattern in the two MOF groups. In the MOF-HI group, mean +/- SD cytokines IL-1beta and IL-6 (pg/ml) were respectively 216 +/- 100 and 461 +/- 343 in the hepatic sinusoidal blood; 149 +/- 52 and 293 +/- 204 in pulmonary capillary blood; and 148 +/- 105 and 234 +/- 162 in peripheral venous blood. In the MOF-ARDS group the corresponding levels were 180 +/- 103 and 235 +/- 124; 235 +/- 94 and 280 +/- 108; and 130 +/- 77 and 194 +/- 127. The TNF-alpha levels also exhibited the same pattern. The mean +/- SD corresponding levels (mmol/L) for lactate in the MOF-HI group were 3.1 +/- 1.8, 1.5 +/- 0.3, and 1.2 +/- 0.6, and in the MOF-ARDS group were 1.1 +/- 0.9, 1.8 +/- 1.1, and 1.0 +/- 0.2, respectively. The differences in the levels of all substances between the liver and lungs in the two MOF groups were statistically significant (p < 0.003). In the study of transpulmonary gradients it was shown that the levels of cytokine and lactate were lower in arterial blood than in mixed venous blood in MOF-HI patients, whereas the opposite was true in MOF-ARDS patients. In this study, we found that in MOF, cytokines and lactate are secreted from the most severely affected organs.
为了探究多器官功能衰竭（MOF）患者体内细胞因子和乳酸浓度是否存在器官特异性模式，我们检测了10例合并肝脏受累的MOF患者（MOF-HI）、8例合并成人呼吸窘迫综合征的MOF患者（MOF-ARDS）以及5例头部受伤患者（对照组）的肝静脉、肺毛细血管和外周静脉血中的细胞因子白细胞介素-1β（IL-1β）、IL-6和肿瘤坏死因子-α（TNF-α）以及乳酸。另外10例患者参与了这些物质的肺动静脉浓度梯度研究。统计分析采用非参数检验和方差分析（ANOVA）。这两种MOF组中这些物质的区域浓度呈现出不同模式。在MOF-HI组中，肝窦血中细胞因子IL-1β和IL-6（pg/ml）的均值±标准差分别为216±100和至461±343；肺毛细血管血中为149±52和293±204；外周静脉血中为148±105和234±162。在MOF-ARDS组中，相应水平分别为180±103和235±124；235±94和280±108；130±77和194±127。TNF-α水平也呈现相同模式。MOF-HI组中乳酸的相应均值±标准差水平（mmol/L）分别为3.1±1.8、1.5±0.3和1.2±0.6，MOF-ARDS组中分别为1.1±0.9、1.8±1.1和1.0±0.2。两组MOF患者肝脏与肺之间所有物质水平的差异具有统计学意义（p<0.003）。在肺跨膜梯度研究中发现，MOF-HI患者动脉血中细胞因子和乳酸水平低于混合静脉血，而MOF-ARDS患者情况则相反。在本研究中，我们发现MOF患者中，细胞因子和乳酸是从受影响最严重的器官分泌的。
