Ebihara I, Nakamura T, Shimada N, Shoji H, Koide H
Department of Medicine, Koto Hospital, Tokyo, Japan.
Am J Kidney Dis. 1998 Dec;32(6):953-61. doi: 10.1016/s0272-6386(98)70069-1.
Hemoperfusion using polymyxin B-immobilized fiber (PMX-F) is reported to be an effective treatment for sepsis. The aim of the present study is to assess whether plasma endothelin-1 (ET-1) and ET-1 messenger RNA (mRNA) levels in peripheral-blood monocytes are altered in patients with sepsis and whether PMX-F treatment affects plasma ET-1 and monocyte ET-1 mRNA levels. Sixteen patients with sepsis and 20 healthy volunteers were included in this study. Plasma ET-1 concentration was measured by radioimmunoassay (RIA), and plasma levels of transforming growth factor-beta (TGF-beta), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta (IL-1beta) were measured by enzyme-linked immunosorbent assay (ELISA). Sixteen patients with sepsis were treated with direct hemoperfusion using PMX-F columns. Blood endotoxin levels decreased significantly from 35 to 10 pg/mL after two treatments of direct hemoperfusion, each for 2 hours. Patients with sepsis showed significantly increased levels of plasma ET-1 (P < 0.001) and monocyte ET-1 mRNA (P < 0.001) compared with healthy volunteers. However, no differences in plasma levels of TGF-beta, TNF-alpha, and IL-1beta existed between patients with sepsis and healthy volunteers. Increased plasma ET-1 levels and monocyte ET-1 mRNA levels in patients with sepsis decreased significantly after PMX-F treatment (P < 0.01). These data suggest that the secretion of ET-1 from peripheral-blood monocytes may be stimulated by endotoxin, and PMX-F treatment may be effective in reducing ET-1 secretion in patients with sepsis.
据报道，使用多粘菌素B固定化纤维（PMX-F）进行血液灌流是治疗脓毒症的一种有效方法。本研究的目的是评估脓毒症患者外周血单核细胞中血浆内皮素-1（ET-1）和ET-1信使核糖核酸（mRNA）水平是否发生改变，以及PMX-F治疗是否会影响血浆ET-1和单核细胞ET-1 mRNA水平。本研究纳入了16例脓毒症患者和20名健康志愿者。采用放射免疫分析法（RIA）测定血浆ET-1浓度，采用酶联免疫吸附测定法（ELISA）测定血浆转化生长因子-β（TGF-β）、肿瘤坏死因子-α（TNF-α）和白细胞介素-1β（IL-1β）水平。16例脓毒症患者使用PMX-F柱进行直接血液灌流治疗。经过两次每次2小时的直接血液灌流治疗后，血液内毒素水平从35 pg/mL显著降至10 pg/mL。与健康志愿者相比，脓毒症患者的血浆ET-1水平（P < 0.001）和单核细胞ET-1 mRNA水平（P < 0.001）显著升高。然而，脓毒症患者与健康志愿者之间的血浆TGF-β、TNF-α和IL-1β水平没有差异。PMX-F治疗后，脓毒症患者升高的血浆ET-1水平和单核细胞ET-1 mRNA水平显著降低（P < 0.01）。这些数据表明，外周血单核细胞分泌ET-1可能受到内毒素的刺激，PMX-F治疗可能有效降低脓毒症患者的ET-1分泌。
