Hyperglycaemia and apoptosis of microglial cells in human septic shock

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• 作者：Andrea Polito (1)
  Jean-Philippe Brouland (2)
  Raphael Porcher (3)
  Romain Sonneville (1) (6)
  Shidasp Siami (1)
  Robert D Stevens (4)
  Céline Guidoux (1)
  Virginie Maxime (1)
  Geoffroy Lorin de la Grandmaison (5)
  Fabrice C Chrétien (6)
  Fran?oise Gray (2)
  Djillali Annane (1)
  Tarek Sharshar (1)
  
• 刊名：Critical Care
• 出版年：2011
• 出版时间：December 2011
• 年：2011
• 卷：15
• 期：3
• 全文大小：
• 作者单位：Andrea Polito (1)
  Jean-Philippe Brouland (2)
  Raphael Porcher (3)
  Romain Sonneville (1) (6)
  Shidasp Siami (1)
  Robert D Stevens (4)
  Céline Guidoux (1)
  Virginie Maxime (1)
  Geoffroy Lorin de la Grandmaison (5)
  Fabrice C Chrétien (6)
  Fran?oise Gray (2)
  Djillali Annane (1)
  Tarek Sharshar (1)
  
  1. General Intensive Care Medicine, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint Quentin en Yvelines, 104 bd R. Poincaré, Garches, 92210, France
  2. Department of Pathology, Lariboisière Hospital (AP-HP), University Denis Diderot-Paris 7, 2 rue Ambroise Paré, Paris, 75010, France
  3. Departement of Biostatistic and Medical Informatics, Saint-Louis Hospital (APHP), University Denis Diderot-Paris 7, 47-83, boulevard de l’H?pital, Paris, 75010, France
  6. HISTO, Human Histopathology and Animal Models, Institut Pasteur; Département Infection et Epidémiologie, 25 rue du Dr Roux, 75015, Paris, France
  4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA
  5. Department of Pathology, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint Quentin en Yvelines, 104 bd R. Poincaré, Garches, 92210, France
  
• ISSN：1364-8535

文摘

Introduction The effect of hyperglycaemia on the brain cells of septic shock patients is unknown. The objective of this study was to evaluate the relationship between hyperglycaemia and apoptosis in the brains of septic shock patients. Methods In a prospective study of 17 patients who died from septic shock, hippocampal tissue was assessed for neuronal ischaemia, neuronal and microglial apoptosis, neuronal Glucose Transporter (GLUT) 4, endothelial inducible Nitric Oxide Synthase (iNOS), microglial GLUT5 expression, microglial and astrocyte activation. Blood glucose (BG) was recorded five times a day from ICU admission to death. Hyperglycaemia was defined as a BG 200 mg/dL g/l and the area under the BG curve (AUBGC) > 2 g/l was assessed. Results Median BG over ICU stay was 2.2 g/l. Neuronal apoptosis was correlated with endothelial iNOS expression (rho = 0.68, P = 0.04), while microglial apoptosis was associated with AUBGC > 2 g/l (rho = 0.70; P = 0.002). Neuronal and microglial apoptosis correlated with each other (rho = 0.69, P = 0.006), but neither correlated with the duration of septic shock, nor with GLUT4 and 5 expression. Neuronal apoptosis and ischaemia tended to correlate with duration of hypotension. Conclusions In patients with septic shock, neuronal apoptosis is rather associated with iNOS expression and microglial apoptosis with hyperglycaemia, possibly because GLUT5 is not downregulated. These data provide a mechanistic basis for understanding the neuroprotective effects of glycemic control.