N-acetylcysteine decreases lactate signal intensities in liver tissue and improves liver function in septic shock patients, as shown by magnetic resonance spectroscopy:: extended case report

被引:25
作者
Hein, OV
Öhring, R
Schilling, A
Oellerich, M
Armstrong, VW
Kox, WJ
Spies, C
机构
[1] Humboldt Univ, Dept Anesthesiol & Intens Care Med Charite, Berlin, Germany
[2] Free Univ Berlin, Benjamin Franklin Med Ctr, Dept Neurol, D-1000 Berlin, Germany
[3] Univ Gottingen, Dept Clin Chem, D-3400 Gottingen, Germany
来源
CRITICAL CARE | 2004年 / 8卷 / 02期
关键词
lactate; liver perfusion; monoethylglycinexylidide; N-acetylcysteine; proton magnetic resonance imaging; septic shock;
D O I
10.1186/cc2426
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background N-acetylcysteine (NAC) has been shown to improve splanchnic blood flow in experimental studies. This report evaluates the effects of NAC on liver perfusion and lactate signal intensities in the liver tissue of septic shock patients using proton magnetic resonance imaging and spectroscopy. Furthermore, the monoethylglycinexylidide (MEGX) test was used to investigate hepatic function. Methods Five septic shock patients received 150 mg/kg body weight NAC as an intravenous bolus injection over 15 min. Lidocaine was injected both prior to and following NAC administration in order to determine MEGX formation. Measurements (hemodynamics, oxygen transport-related variables, blood samples for lactate, liver-related markers) were performed 1 hour before and 1 hour after NAC injection. In addition to the proton magnetic resonance imaging patients received two proton magnetic resonance spectra, one prior to and one 30 min subsequent to the onset of the NAC infusion at a 1.5 Tesla clinical scanner, for measurement of liver perfusion and liver lactate signal intensity. Main findings Following NAC infusion, the lactate signal intensity in the liver tissue showed a median decrease of 89% (11 - 99%), there was a median increase in liver perfusion of 41% (-14 to 559%), and the MEGX serum concentration increased three times (1.52 - 5.91). Conclusions A decrease in the lactate signal intensity in the liver tissue and an increase in the MEGX serum concentration and in liver perfusion might indicate improved liver function as a result of NAC administration. Patients with compromised hepatosplanchnic function, such as patients with septic shock due to peritonitis, may therefore benefit from NAC therapy.
引用
收藏
页码:R66 / R71
页数:6
相关论文
共 39 条
  • [1] *AM COLL CHEST PHY, 1992, CRIT CARE MED, V30, P864
  • [2] THE ANTIOXIDANT ACTION OF N-ACETYLCYSTEINE - ITS REACTION WITH HYDROGEN-PEROXIDE, HYDROXYL RADICAL, SUPEROXIDE, AND HYPOCHLOROUS ACID
    ARUOMA, OI
    HALLIWELL, B
    HOEY, BM
    BUTLER, J
    [J]. FREE RADICAL BIOLOGY AND MEDICINE, 1989, 6 (06) : 593 - 597
  • [3] INVIVO H-1 SPECTROSCOPY IN HUMANS AT 1.5-T
    BARANY, M
    LANGER, BG
    GLICK, RP
    VENKATASUBRAMANIAN, PN
    WILBUR, AC
    SPIGOS, DG
    [J]. RADIOLOGY, 1988, 167 (03) : 839 - 844
  • [4] EFFECT OF N-ACETYLCYSTEINE ON THE PULMONARY RESPONSE TO ENDOTOXIN IN THE AWAKE SHEEP AND UPON INVITRO GRANULOCYTE FUNCTION
    BERNARD, GR
    LUCHT, WD
    NIEDERMEYER, ME
    SNAPPER, JR
    OGLETREE, ML
    BRIGHAM, KL
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1984, 73 (06) : 1772 - 1784
  • [5] Methods for quantitative assessment of tissue microcirculation using dynamic contrast-enhanced MR imaging
    Brix, G
    Schreiber, W
    Hoffmann, U
    Guckel, F
    Hawighorst, H
    Knopp, MV
    [J]. RADIOLOGE, 1997, 37 (06): : 470 - 480
  • [6] H-1-NMR OBSERVATION OF REDOX POTENTIAL IN LIVER
    CHUNG, YG
    JUE, T
    [J]. BIOCHEMISTRY, 1992, 31 (45) : 11159 - 11165
  • [7] Does hepato-splanchnic Vo2/Do2 dependency exist in critically ill septic patients?
    De Backer, D
    Creteur, J
    Noordally, O
    Smail, N
    Gulbis, B
    Vincent, JL
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 157 (04) : 1219 - 1225
  • [8] DEITCH EA, 1990, ARCH SURG-CHICAGO, V125, P403
  • [9] N-acetylcysteine improves indocyanine green extraction and oxygen transport during hepatic dysfunction
    Devlin, J
    Ellis, AE
    McPeake, J
    Heaton, N
    Wendon, JA
    Williams, R
    [J]. CRITICAL CARE MEDICINE, 1997, 25 (02) : 236 - 242
  • [10] HETEROGENEOUS REGIONAL VASCULAR-RESPONSES TO SIMULATED TRANSIENT HYPOVOLEMIA IN MAN
    EDOUARD, AR
    DEGREMONT, AC
    DURANTEAU, J
    PUSSARD, E
    BERDEAUX, A
    SAMII, K
    [J]. INTENSIVE CARE MEDICINE, 1994, 20 (06) : 414 - 420