JAMA:维生素C不能改善脓毒症和急性呼吸窘迫综合征(ARDS)相关的炎症和血管损伤

2019-10-02 MedSci MedSci原创

注射维生素C不能改善脓毒症和急性呼吸窘迫综合征(ARDS)相关的炎症和血管损伤

实验室研究表明,静脉注射维生素C可减轻与脓毒症和急性呼吸窘迫综合征(ARDS)相关的炎症和血管损伤。近日研究人员开展随机临床研究,考察了静脉输注维生素C对脓毒症和急性呼吸窘迫综合征(ARDS)患者器官功能衰竭评分、炎症和血管损伤生物学指标物的影响。

CITRIS-ALI为随机、双盲、安慰剂对照多中心研究,在美国7个ICU中心开展,167名确诊24小时内的脓毒症和急性呼吸窘迫综合征患者参与,随机接受静脉输注维生素C(50 mg/kg,5%的葡萄糖注射液,n=84)或安慰剂(n=83),每6小时一次,持续96小时。研究的主要结果是器官功能衰竭变化,用改良的序贯性器官功能衰竭评分法进行评估(0-20,分数高,功能衰竭更严重)。在0,48,96和168小时测定血浆炎症(c-反应蛋白水平)和血管损伤(血栓调节蛋白水平)标志物。

患者平均年龄54.8岁,男性90人,62%的参与者完成60天研究。组间主要终点发生率差异不显著(维生素C组得分由9.8分下降至6.8分,安慰剂组由10.3分下降至6.8分)。组间168小时时C反应蛋白(54.1 vs 46.1 μg/m) 以及血栓调节蛋白水平 (14.5 vs 13.8 ng/mL) 差异不显著。

研究认为,注射维生素C不能改善脓毒症和急性呼吸窘迫综合征(ARDS)相关的炎症和血管损伤。

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