微量アルブミン尿症の程度は血管内皮障害と多臓器障害の程度と相関する

• 小池 薫

  日本医科大学救急医学

• 望月 徹

  日本医科大学救急医学

• 久志本 成樹

  日本医科大学救急医学

• 柴田 泰史

  日本医科大学救急医学

• 小井土 雄一

  日本医科大学救急医学

• 辻井 厚子

  日本医科大学救急医学

• 山本 保博

  日本医科大学救急医学

書誌事項

タイトル別名

• Microalbuminuria Correlates with Endothelial Injury and Multiple Organ Dysfunction. A Preliminary Study. A. Preliminary Study.
• A Preliminary Study

抄録

An early feature of acute respiratory distress syndrome and multiple organ dysfunction syndrome is vascular endothelial cell injury and subsequent increase in generalized microvascular permeability. It has recently been postulated that the level of microalbuminuria represents generalized microvascular permeability in the clinical setting. The purpose of this study was to ascertain whether the extent of microalbuminuria correlates with the level of endothelial cell injury, the severity of illness, and the magnitude of impaired respiratory function and multiple organ dysfunction in patients who required therapeutic interventions. Methods: Fourteen consecutive ICU patients who required emergent operation or non-invasive interventions were studied. Urine albumin/creatinine ratio (ACR) and the circulating markers of endothelial cell injury, i.e., serum thrombomodulin (TM) and plasma von Willebrand factor antigen (vWF), were measured within 24 hours after intervention. The data of Acute Physiology and Chronic Health Evaluation II score (APACHE II), simplified acute physiology score (SAPS), multiple organ dysfunction score (MODs), sequential organ failure assessment (SOFA), PaO₂/FiO₂ ratio, lunginjury score (LIS), white blood cell count (WBC) in the blood, and serum C-reactive protein (CRP) were obtained daily during the first 7 days. The relationships between ACR and other variables were assessed. Results: During the first 24 hours after intervention, there was an increase in ACR (280±86mg/g) above normal value (<10mg/g). Log ACR showed a significant correlation with serum TM, but not with plasma vWF. When the levels of Log ACR were compared to other clinical variables obtained within the first 24 hours, the increase in Log ACR correlated positively with APACHE II, SAPS, MODs, SOFA and LIS. Log ACR correlated negatively with PaO₂/FiO₂ ratio. Log ACR did not correlate with WBC, or CRP. When the levels of Log ACR were compared to the worst data of those variables measured during the first week, Log ACR correlated positively with the worst data of APACHE II, SAPS, MODs, SOFA, and LIS. Log ACR correlated negatively with the worst data of PaO₂/FiO₂ ratio. Log ACR did not show any relation with WBC, or CRP. Conclusion: The extent of urinary ACR measured during the first 24 hours after intervention correlated with the level of endothelial cell injury, the severity of illness, and the magnitude of impaired respiratory function and multiple organ dysfunction. These findings appear to support the hypothesis that microalbuminuria represents the magnitude of generalized microvascular permeability.

収録刊行物

• 日本救急医学会雑誌

  日本救急医学会雑誌 11 (6), 261-268, 2000

  一般社団法人 日本救急医学会

キーワード

• アルブミン尿症
• 多臓器不全
• 急性呼吸促迫症候群
• 血管内皮
• 血管透過性

詳細情報

• CRID: 1390282679347319168
• NII論文ID: 130003625760
• DOI: 10.3893/jjaam.11.261
• ISSN: 18833772
• ISSN: 0915924X
• 本文言語コード: en
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可