asymmetric dimethylarginine, endothelial nitric oxide bioavailability and mortality in sepsis不对称dimethylarginine、内皮一氧化氮的生物利用度和脓毒症的死亡率.pdfVIP

Asymmetric Dimethylarginine, Endothelial Nitric Oxide Bioavailability and Mortality in Sepsis 1,2 . 1. 1,2 1 1 Joshua S. Davis * , Christabelle J. Darcy , Tsin W. Yeo , Catherine Jones , Yvette R. McNeil , 4 3 1,2 Dianne P. Stephens , David S. Celermajer , Nicholas M. Anstey 1 International Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia, 2 Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia, 3 Department of Medicine, University of Sydney and Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, 4 Intensive Care Unit, Royal Darwin Hospital, Darwin, Northern Territory, Australia Abstract Background: Plasma concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, are raised in patients with chronic vascular disease, causing increased cardiovascular risk and endothelial dysfunction, but the role of ADMA in acute inflammatory states is less well defined. Methods and Results: In a prospective longitudinal study in 67 patients with acute sepsis and 31 controls, digital microvascular reactivity was measured by peripheral arterial tonometry and blood was collected at baseline and 2–4 days later. Plasma ADMA and L-arginine concentrations were determined by high performance liquid chromatography. Baseline plasma L-arginine: ADMA ratio was significantly lower in sepsis patients (median [IQR] 63 [45–103]) than in hospital controls (14