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Titolo:
Close relationship of tissue plasminogen activator-plasminogen activator inhibitor-1 complex with multiple organ dysfunction syndrome investigated bymeans of the artificial pancreas
Autore:
Hoshino, M; Haraguchi, Y; Hirasawa, H; Sakai, M; Saegusa, H; Hayashi, K; Horita, N; Ohsawa, H;
Indirizzi:
Tokyo Police Hosp, Dept Intens & Crit Care Med, Chiyoda Ku, Tokyo 102, Japan Tokyo Police Hosp Tokyo Japan 102 Care Med, Chiyoda Ku, Tokyo 102, Japan Natl Hosp Tokyo Disaster Med Ctr, Tachikawa, Tokyo, Japan Natl Hosp Tokyo Disaster Med Ctr Tachikawa Tokyo Japan awa, Tokyo, Japan Chiba Univ, Sch Med, Dept Emergency & Crit Care Med, Chou Ku, Chiba 280, Japan Chiba Univ Chiba Japan 280 cy & Crit Care Med, Chou Ku, Chiba 280, Japan
Titolo Testata:
CRITICAL CARE
fascicolo: 2, volume: 5, anno: 2001,
pagine: 88 - 99
SICI:
1466-609X(2001)5:2<88:CROTPA>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
DISSEMINATED INTRAVASCULAR COAGULATION; CORONARY-ARTERY DISEASE; DEPENDENT DIABETES-MELLITUS; SMOOTH-MUSCLE CELLS; ANTITHROMBIN-III; FIBRINOLYTIC-ACTIVITY; CARDIOVASCULAR RISK; INSULIN-RESISTANCE; ENDOTHELIAL-CELLS; SEVERE SEPSIS;
Keywords:
artificial pancreas; coagulopathy; diabetes mellitus; multiple organ dysfunction syndrome; tissue plasminogen activator-plasminogen activator inhibitor-1 complex;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
48
Recensione:
Indirizzi per estratti:
Indirizzo: Hoshino, M Tokyo Police Hosp, Dept Intens & Crit Care Med, Chiyoda Ku, Fujimi 2-10-41, Tokyo 102, Japan Tokyo Police Hosp Fujimi 2-10-41 Tokyo Japan102 yo 102, Japan
Citazione:
M. Hoshino et al., "Close relationship of tissue plasminogen activator-plasminogen activator inhibitor-1 complex with multiple organ dysfunction syndrome investigated bymeans of the artificial pancreas", CRIT CARE, 5(2), 2001, pp. 88-99

Abstract

Background: Glucose tolerance (GT) has not been taken into consideration in investigations concerning relationships between coagulopathy and multipleorgan dysfunction syndrome (MODS), and endothelial cell activation/endothelial cell injury (ECA/ECI) in septic patients, although coagulopathy is known to be influenced by blood glucose level. We investigated those relationships under strict blood glucose control and evaluation of GT with the glucose clamp method by means of the artificial pancreas in nine septic patientswith glucose intolerance. The relationships between GT and blood stress related hormone levels (SRH) were also investigated. Methods: The amount of metabolized glucose (M value), as the parameter of GT, was measured by the euglycemic hyperinsulinemic glucose clamp method, in which the blood glucose level was clamped at 80 mg/dl under a continuous insulin infusion rate of 1.12 mU/kg per min, using the artificial pancreas,STG-22. Multiple organ failure (MOF) score was calculated using the MOF criteria of Japanese Association for Critical Care Medicine. Regarding coagulopathy, the following parameters were used: disseminated intravascular coagulation (DIC) score (calculated from the DIC criteria of the Ministry of Health and Welfare of Japan) and the parameters used for calculating DIC score, protein-C, protein-S, plasminogen, antithrombin III (AT-III), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator-PAl-1 (tPA-PAI-1) complex. Thrombomodulin (TM) was measured as the indicator of ECI. Results: There were no significant correlations between M value and SRH, parameters indicating coagulopathy and the MOF score. The MOF score and blood TM levels were positively correlated with DIC score, thrombin-AT-lll complex and tPA-PAI-1 complex, and negatively correlated with blood platelet count. Conclusions: GT was not significantly related to SRH, coagulopathy and MODS under strict blood glucose control. Hypercoagulability was closely related to MODS and ECI. Among the parameters indicating coagulopathy, tPA-PAI-1 complex, which is considered to originate from EGA, seemed to be a sensitive parameter of MODS and ECI, and might be a predictive marker of MODS. The treatment for reducing hypercoagulability and ECA/ECI were thought to be justified as one of the therapies for acutely ill septic patients.

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Documento generato il 29/03/20 alle ore 12:08:46