栗山 直英

The high mobility group box 1 protein (HMGB1) is an alarmin that plays an important role in sepsis and has been recognized as a promising target with a wide therapeutic window; however, no drugs and devices are currently in practical use. We hypothesized that hemofilters composed of porous membranes or cytokine-adsorbing membranes could remove HMGB1 from the blood. We performed experimental hemofiltration in vitro using four types of hemofilters composed of different membranes specifically designed for continuous hemofiltration. The test solution was a 1000-mL substitution fluid containing 100 mu g of HMGB1 and 35 g of bovine serum albumin. Experimental hemofiltration was conducted for 360 min in a closed loop circulation system. Among the four membranes, surface-treated polyacrylonitrile (AN69ST) showed the highest capacity to adsorb HMGB1; it adsorbed nearly 100 mu g of HMGB1 in the initial 60 min and showed a markedly high clearance rate (60.8 +/- 5.0 mL/min) at 15 min. The polymethylmethacrylate membrane had half of the adsorption capacity of the AN69ST membrane. Although the highest sieving coefficient for HMGB1 was obtained with the high cut-off polyarylethersulfone membrane, which correlated with a constant filtrate clearance rate, albumin loss was observed. However, no such removal of both HMGB1 and albumin was observed with the polysulfone membrane and tubing. We conclude that continuous hemofiltration using the AN69ST membrane is a promising approach for HMGB1-related sepsis.

ICU入室時のThrombin-antithrombin complex(TAT)値および乳酸値と、SOFAスコア、APACHE IIスコアとICU室期間との関連を調べ、重症度の判定や予後予測の指標になり得るか検討した。ICUに3日間以上滞在し、28日間以内に退室した連続30例を対象とした。入室期間が7日間未満(A群)と7日間以上(B群)で2群に分けた。ICU入室時のTAT値とSOFAスコアは正の相関関係を示し、ICU入室時のTATとAPACHE IIスコアも正の相関関係を示した。TAT値はB群で有意に高かった。血清乳酸値もB群で有意に高かった。また、SOFAスコアはB群で有意に高く、APACHE IIスコアもB群で有意に高かった。

Purpose: The present study was performed to clarify the relationships between body mass index (BMI), interleukin-6 (IL-6) production, and respiratory muscle weakness in patients undergoing coronary artery bypass grafting (CABG). Materials and Methods: The correlations among BMI, changes in maximum inspiratory and expiratory pressure (Delta MIP, Delta MEP) on postoperative days (POD) 1 and 7, postoperative IL-6, and rapid turnover proteins (retinol-binding protein, prealbumin, and transferrin) on POD1 were assessed in 154 consecutive patients undergoing elective CABG. The patients were divided into quartiles of BMI, Q1 (BMI, <20.8 kg/m(2)) to Q4 (BMI, = >= 25.25 kg/m(2)), and compared among groups. Results: There were significant correlations between Delta MIP and BMI (POD1, r = -0.369; POD7, r = -0.285) and IL-6 (POD1, r = 0.423; POD7, r = 0.431), and between Delta MEP and BMI (POD1, r = -0.252; POD7, r = -0.228) and IL-6 (POD1, r = 0.252; POD7, r = 0.384). Interleukin-6 showed a significant negative correlation with BMI (r = -0.374) and retinol-binding protein (r = -0.382). Interleukin-6 was highest in Q1 and lowest in Q4. Higher BMI indicated greater respiratory muscle strength than lower BMI. Conclusions: Preoperative BMI is correlated with respiratory muscle strength and cytokine production after CABG. The findings of this study suggest that BMI may be a valuable predictor for respiratory management in CABG patients. (C) 2010 Elsevier Inc. All rights reserved.