A novel in vivo rabbit model of hypercatabolic critical illness reveals a biphasic neuroendocrine stress response

被引:64
作者
Weekers, F [1 ]
Van Herck, E
Coopmans, W
Michalaki, M
Bowers, CY
Veldhuis, JD
Van den Berghe, G
机构
[1] Catholic Univ Leuven, Dept Intens Care Med, B-3000 Louvain, Belgium
[2] Catholic Univ Leuven, Burn Unit, B-3000 Louvain, Belgium
[3] Catholic Univ Leuven, Ctr Expt Surg & Anesthesiol, B-3000 Louvain, Belgium
[4] Catholic Univ Leuven, Lab Expt Med & Endocrinol, B-3000 Louvain, Belgium
[5] Tulane Univ, Med Ctr, Dept Med, Div Endocrinol, New Orleans, LA 70112 USA
[6] Univ Virginia, Hlth Sci Ctr, Dept Med, Div Endocrinol, Charlottesville, VA USA
关键词
D O I
10.1210/en.143.3.764
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
High doses of GH, used to induce anabolism in prolonged critically ill patients, unexpectedly increased mortality. To further explore underlying mechanisms, a valid animal model is needed. Such a model is presented in this study. Seven days after arterial and venous cannulae placement, male New Zealand White rabbits were randomly allocated to a control or a critically ill group. To induce prolonged critical illness, a template controlled 15% deep dermal burn injury was imposed under combined general and regional (paravertebral) anesthesia. Subsequently, critically ill rabbits received supplemental analgesia and were parenterally fed with glucose, insulin, amino acids, and lipids. On d I and d 8 after randomization, acute and chronic spontaneous hormonal profiles of GH, TSH, and PRL secretion were obtained by sampling blood every 15 min for 7 h. Furthermore, GH, TSH, and PRL responses to an iv bolus of GH-releasing peptide 2 (GHRP-2) + TRH were documented on d 0, 1, and 8. Hemodynamic status and biochemical parameters were evaluated on d 0, 1, 3, 5, and S, after which animals were killed and relative wet weight and water content of organs was determined. Compared with controls, critically ill animals exhibited transient metabolic acidosis on d I and weight loss, organ wasting, systolic hypertension, and pronounced anemia on d S. On d 1, pulsatile GH secretion doubled in the critically ill animals compared with controls, and decreased again on d 8 in the presence of low plasma IGF-I concentrations from d 1 to d 8. GH responses to GHRP-2 + TRH were elevated on d 1 and increased further on d 8 in the critically ill animals. Mean TSH concentrations were identical in both groups on d I and 8, in the face of dramatically suppressed plasma T-4 and T-3 concentrations in the critically ill animals. PRL secretion was impaired in the critically ill animals exclusively on d S. TSH and PRL responses to GHRP-2 and TRH were increased only on d 1. In conclusion, this rabbit model of acute and prolonged critical illness reveals several of the clinical, biochemical, and endocrine manifestations of the human counterpart.
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收藏
页码:764 / 774
页数:11
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