Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Correlation of Nitric Oxide and Corticosteroids Along the Course of Sepsis

패혈증의 경과에 따른 혈중 스테로이드와 Nitric Oxide의 연관성

  • Lee, Keu Sung (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Kim, Young Sun (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Lee, Hyoung No (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Park, Joo Hun (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Oh, Yoon Jung (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Sheen, Seung Soo (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Choi, Young Hwa (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Park, Kwang Joo (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Hwang, Sung Chul (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine)
  • 이규성 (아주대학교 의과대학 호흡기내과학교실) ;
  • 김영선 (아주대학교 의과대학 호흡기내과학교실) ;
  • 이형노 (아주대학교 의과대학 호흡기내과학교실) ;
  • 박주헌 (아주대학교 의과대학 호흡기내과학교실) ;
  • 오윤정 (아주대학교 의과대학 호흡기내과학교실) ;
  • 신승수 (아주대학교 의과대학 호흡기내과학교실) ;
  • 최영화 (아주대학교 의과대학 호흡기내과학교실) ;
  • 박광주 (아주대학교 의과대학 호흡기내과학교실) ;
  • 황성철 (아주대학교 의과대학 호흡기내과학교실)
  • Received : 2006.11.29
  • Accepted : 2007.03.22
  • Published : 2007.04.30
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Abstract

Background: The nitric oxide (NO) released by inducible NO synthase (iNOS) plays an important role in the pathophysiology of sepsis. Corticosteroids also play a role in the hemodynamic and inflammatory reactions in sepsis. Both have been shown to have a relationship theoretically, but their correlation and clinical impacts have rarely been evaluated. Methods: 26 patients with sepsis and 14 healthy controls were enrolled in this study. The initial random plasma total NO and the serum cortisol levels were measured. The same measurements were serially carried out on the $3^{rd}$, $5^{th}$, and $7^{th}$ days. Results: The initial total plasma levels of NO and cortisol were higher in the patients with sepsis than in the healthy controls. The total NO levels were higher in patients with severe sepsis than in the those with mild sepsis. There was a correlation between the total NO and cortisol level throughout the study. Conclusion: In patients with sepsis, the levels of plasma NO and cortisol were well correlated during the first week of sepsis, which suggests an interrelationship. However, the clinical and pathogenetic implications await further evaluation.

연구배경: 패혈증에서 Nitric oxide 스테로이드 호르몬은 혈역학적 변화와 염증반응에 관여하는데 이 두 인자는 서로 상관성이 있는 것으로 알려지고 있다. 하지만 실제 환자에서 서로의 상관성이나 임상적 의의는 연구가 부족한 실정이다. 방법: 패혈증 환자 26예와 대조군 14예를 대상으로 혈중 총 NO와 혈중 코티졸 농도를 측정하였고 이어서 제 3, 5, 7병일에도 연속적으로 측정을 하였다. 결과: 패혈증 환자군에서 초기 혈중 코티졸 및 총 NO 농도는 대조군에 비하여 유의하게 증가하였고 경증 패혈증에 비하여 중증 패혈증 환자군에서 유의하게 높았다. 초기 혈중 총 NO의 농도는 APACHE II 점수, 정맥혈 lactate 농도와 상관성이 있었다. 패혈증의 시간의 경과에 따라 혈중 NO 농도는 제 1병일, 제 5병일, 제 7병일에 혈중 코티졸의 농도와 유의한 상관성이 있었다. 결론: 패혈증 환자들에서 혈중 NO와 코티졸 농도는 증가되어 있었으며, 경과에 따라 서로 유의한 상관성이 지속되었다. 상호작용기전에 대하여는 추가적인 연구가 필요할 것이다.

Keywords

References

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