{"id":17842,"date":"2019-10-12T05:31:09","date_gmt":"2019-10-11T21:31:09","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17842"},"modified":"2019-10-29T22:50:47","modified_gmt":"2019-10-29T14:50:47","slug":"jama%e6%9c%80%e6%96%b0%e8%ae%ba%e6%96%87%ef%bc%9a%e8%be%93%e6%b3%a8%e7%bb%b4%e7%94%9f%e7%b4%a0c%e5%af%b9%e5%90%88%e5%b9%b6%e4%b8%a5%e9%87%8d%e5%91%bc%e5%90%b8%e5%8a%9f%e8%83%bd%e8%a1%b0%e7%ab%ad","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17842","title":{"rendered":"[JAMA\u6700\u65b0\u8bba\u6587]\uff1a\u8f93\u6ce8\u7ef4\u751f\u7d20C\u5bf9\u5408\u5e76\u4e25\u91cd\u547c\u5438\u529f\u80fd\u8870\u7aed\u7684\u8113\u6bd2\u75c7\u60a3\u8005\u5668\u5b98\u529f\u80fd\u8870\u7aed\u53ca\u708e\u75c7\u548c\u8840\u7ba1\u635f\u4f24\u751f\u7269\u6807\u5fd7\u7269\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Preliminary Communication Caring for the Critically Ill PatientOctober 1, 2019<\/p>\n\n\n\n

Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial<\/h1>\n\n\n\n

Alpha A. Fowler III, Jonathon D. Truwit, R. Duncan Hite, et al<\/h3>\n\n\n\n

JAMA. <\/em>2019;322(13):1261-1270. doi:10.1001\/jama.2019.11825<\/h3>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h3>\n\n\n\n

Experimental data suggest that intravenous vitamin C may attenuate inflammation and vascular injury associated with sepsis and acute respiratory distress syndrome (ARDS).<\/p>\n\n\n\n

\u8bd5\u9a8c\u6570\u636e\u63d0\u793a\uff0c\u5408\u5e76ARDS\u7684\u8113\u6bd2\u75c7\u60a3\u8005\u9759\u8109\u8f93\u6ce8\u7ef4\u751f\u7d20C\u80fd\u591f\u51cf\u8f7b\u708e\u75c7\u53cd\u5e94\u548c\u8840\u7ba1\u635f\u4f24\u3002<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h3>\n\n\n\n

To determine the effect of intravenous vitamin C infusion on organ failure scores and biological markers of inflammation and vascular injury in patients with sepsis and ARDS.<\/p>\n\n\n\n

\u786e\u5b9a\u5408\u5e76ARDS\u7684\u8113\u6bd2\u75c7\u60a3\u8005\u9759\u8109\u8f93\u6ce8\u7ef4\u751f\u7d20C\u5bf9\u4e8e\u5668\u5b98\u529f\u80fd\u8870\u7aed\u8bc4\u5206\u53ca\u708e\u75c7\u4e0e\u8840\u7ba1\u635f\u4f24\u751f\u7269\u6807\u5fd7\u7269\u7684\u5f71\u54cd<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1\u3001\u573a\u666f\u53ca\u7814\u7a76\u5bf9\u8c61<\/p>\n\n\n\n

The CITRIS-ALI trial was a randomized, double-blind, placebo-controlled, multicenter trial conducted in 7 medical intensive care units in the United States, enrolling patients (N\u2009=\u2009167) with sepsis and ARDS present for less than 24 hours. The study was conducted from September 2014 to November 2017, and final follow-up was January 2018.<\/p>\n\n\n\n

CITRIS-ALI\u8bd5\u9a8c\u662f\u4e00\u9879\u968f\u673a\u3001\u53cc\u76f2\u3001\u5b89\u6170\u5242\u5bf9\u7167\u3001\u591a\u4e2d\u5fc3\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u5728\u7f8e\u56fd7\u4e2a\u5185\u79d1ICU\u8fdb\u884c\u3002\u5165\u9009\u8113\u6bd2\u75c7\u5408\u5e76ARDS\u4e14\u53d1\u75c5\u4e0d\u8db324\u5c0f\u65f6\u7684\u60a3\u8005(n = 167)\u3002\u8bd5\u9a8c\u4e8e2014\u5e749\u6708\u81f32017\u5e7411\u6708\u8fdb\u884c\uff0c\u6700\u540e\u968f\u8bbf\u81f32018\u5e741\u6708\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd<\/h3>\n\n\n\n

Patients were randomly assigned to receive intravenous infusion of vitamin C (50 mg\/kg in dextrose 5% in water, n\u2009=\u200984) or placebo (dextrose 5% in water only, n\u2009=\u200983) every 6 hours for 96 hours.<\/p>\n\n\n\n

\u60a3\u8005\u88ab\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d7\u9759\u8109\u8f93\u6ce8\u7ef4\u751f\u7d20C (50 mg\/kg\u6eb6\u4e8e5%\u7684\u8461\u8404\u7cd6\u6eb6\u6db2, n\u2009=\u200984) \u6216\u5b89\u6170\u5242 (5%\u8461\u8404\u7cd6\u6eb6\u6db2, n\u2009=\u200983)\uff0cq6h\uff0c\u7597\u7a0b96\u5c0f\u65f6\u3002 <\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

The primary outcomes were change in organ failure as assessed by a modified Sequential Organ Failure Assessment score (range, 0-20, with higher scores indicating more dysfunction) from baseline to 96 hours, and plasma biomarkers of inflammation (C-reactive protein levels) and vascular injury (thrombomodulin levels) measured at 0, 48, 96, and 168 hours.<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u4e3a\u5668\u5b98\u529f\u80fd\u8870\u7aed\u7684\u53d8\u5316\uff0c\u6839\u636e\u57fa\u7ebf\u81f396\u5c0f\u65f6\u95f4\u4fee\u8ba2\u540eSOFA\u8bc4\u5206\uff08\u8bc4\u5206\u8303\u56f40-20\uff0c\u5206\u503c\u8d8a\u9ad8\u63d0\u793a\u5668\u5b98\u529f\u80fd\u969c\u788d\u8d8a\u4e25\u91cd\uff09\u8fdb\u884c\u8bc4\u4f30\uff0c\u540c\u65f6\uff0c\u57280\uff0c48\uff0c96\u548c168\u5c0f\u65f6\u6d4b\u5b9a\u8840\u6d46\u708e\u75c7\uff08C\u53cd\u5e94\u86cb\u767d\u6c34\u5e73\uff09\u53ca\u8840\u7ba1\u635f\u4f24\uff08\u8840\u6813\u8c03\u8282\u86cb\u767d\u6c34\u5e73\uff09\u751f\u7269\u6807\u5fd7\u7269\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

Among 167 randomized patients (mean [SD] age, 54.8 years [16.7]; 90 men [54%]), 103 (62%) completed the study to day 60. There were no significant differences between the vitamin C and placebo groups in the primary end points of change in mean modified Sequential Organ Failure Assessment score from baseline to 96 hours (from 9.8 to 6.8 in the vitamin C group [3 points] and from 10.3 to 6.8 in the placebo group [3.5 points]; difference, \u22120.10; 95% CI, \u22121.23 to 1.03; P<\/em>\u2009=\u2009.86) or in C-reactive protein levels (54.1 vs 46.1 \u03bcg\/mL; difference, 7.94 \u03bcg\/mL; 95% CI, \u22128.2 to 24.11; P<\/em>\u2009=\u2009.33) and thrombomodulin levels (14.5 vs 13.8 ng\/mL; difference, 0.69 ng\/mL; 95% CI, \u22122.8 to 4.2; P<\/em>\u2009=\u2009.70) at 168 hours.<\/p>\n\n\n\n

\u5728167\u540d\u63a5\u53d7\u968f\u673a\u5206\u7ec4\u7684\u60a3\u8005(\u5e73\u5747[SD]\u5e74\u9f84, 54.8 \u5c81 [16.7]; 90\u540d\u7537\u6027 [54%])\u4e2d\uff0c103\u540d (62%) \u5b8c\u6210\u8bd5\u9a8c\u81f3\u7b2c60\u5929\u3002\u7ef4\u751f\u7d20C\u7ec4\u4e0e\u5b89\u6170\u5242\u7ec4\u4e3b\u8981\u9884\u540e\u7ec8\u70b9\u5373\u4fee\u8ba2\u540eSOFA\u8bc4\u5206\u4ece\u57fa\u7ebf\u6c34\u5e73\u523096\u5c0f\u65f6\u7684\u53d8\u5316\u6ca1\u6709\u663e\u8457\u5dee\u5f02(\u7ef4\u751f\u7d20C\u7ec4\u4ece9.8\u5206\u4e0b\u964d\u52306.8\u5206 [3 \u5206]\uff0c\u5b89\u6170\u5242\u7ec4\u4ece10.3\u5206\u4e0b\u964d\u52306.8\u5206[3.5 \u5206]; \u5dee\u5f02, \u22120.10; 95% CI, \u22121.23 to 1.03; P<\/em>\u2009=\u2009.86)\uff0c\u81f3168\u5c0f\u65f6C-\u53cd\u5e94\u86cb\u767d\u6c34\u5e73 (54.1 vs 46.1 \u03bcg\/mL; \u5dee\u5f02, 7.94 \u03bcg\/mL; 95% CI, \u22128.2 to 24.11; P<\/em>\u2009=\u2009.33) \u548c\u8840\u6813\u8c03\u8282\u86cb\u767d\u6c34\u5e73 (14.5 vs 13.8 ng\/mL; \u5dee\u5f02, 0.69 ng\/mL; 95% CI, \u22122.8 to 4.2; P<\/em>\u2009=\u2009.70) \u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong> \u7ed3\u8bba\u4e0e\u610f\u4e49<\/h3>\n\n\n\n

In this preliminary study of patients with sepsis and ARDS, a 96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury. Further research is needed to evaluate the potential role of vitamin C for other outcomes in sepsis and ARDS.<\/p>\n\n\n\n

\u5728\u8fd9\u9879\u6709\u5173\u8113\u6bd2\u75c7\u5408\u5e76ARDS\u7684\u521d\u6b65\u7814\u7a76\u4e2d\uff0c\u4e0e\u5b89\u6170\u5242\u76f8\u6bd4\uff0c\u7ef4\u751f\u7d20C\u8f93\u6ce896\u5c0f\u65f6\u4e0d\u80fd\u663e\u8457\u6539\u5584\u5668\u5b98\u529f\u80fd\u969c\u788d\u8bc4\u5206\uff0c\u4e5f\u4e0d\u80fd\u6539\u53d8\u708e\u75c7\u548c\u8840\u7ba1\u635f\u4f24\u6807\u5fd7\u7269\u3002\u9700\u8981\u8fdb\u4e00\u6b65\u7814\u7a76\u8bc4\u4f30\u7ef4\u751f\u7d20C\u5bf9\u8113\u6bd2\u75c7\u548cARDS\u60a3\u8005\u5176\u4ed6\u9884\u540e\u6307\u6807\u7684\u53ef\u80fd\u5f71\u54cd\u3002<\/p>\n\n\n\n

Trial Registration<\/strong> \u8bd5\u9a8c\u6ce8\u518c<\/h3>\n\n\n\n

ClinicalTrials.gov Identifier:\u00a0NCT02106975<\/a><\/p>\n\n\n\n

\u8bc4\u8bba[\u4ec5\u4ee3\u8868\u4e2a\u4eba\u89c2\u70b9]<\/h3>\n\n\n\n
  • \u5c3d\u7ba1\u8fd9\u9879\u7814\u7a76\u65e9\u4e8e\u9488\u5bf9\u611f\u67d3\u6027\u4f11\u514b\u7684\u9e21\u5c3e\u9152\u7814\u7a76\uff0c\u800c\u4e14\u662f\u4e00\u9879RCT\uff0c\u4f46\u662f\uff0c\u4ecd\u7136\u63d0\u51fa\u4e00\u4e2a\u503c\u5f97\u601d\u8003\u7684\u95ee\u9898\uff0c\u4e3a\u4f55\u5bf9\u4e8e\u611f\u67d3\u6027\u4f11\u514b\u548c\uff08\u6216\uff09ARDS\u8fd9\u4e9b\u4e34\u5e8a\u7efc\u5408\u5f81\uff0c\u4e00\u79cd\u836f\u7269\u6cbb\u7597\u53ef\u80fd\u594f\u6548\uff1f\u5c24\u5176\u662f\u5728\u5404\u79cd\u590d\u6742\u53d1\u75c5\u673a\u5236\u4e4b\u95f4\u76f8\u4e92\u5f71\u54cd\u5c1a\u4e0d\u6e05\u695a\u7684\u65f6\u5019\u3002<\/li>
  • \u9700\u8981\u6307\u51fa\u7684\u662f\uff0c\u76ee\u524d\u6b63\u5728\u8fdb\u884c\u591a\u9879\u6709\u5173\u5305\u62ec\u7ef4\u751f\u7d20C\u5728\u5185\u7684\u9e21\u5c3e\u9152\u7597\u6cd5\u6cbb\u7597\u611f\u67d3\u6027\u4f11\u514b\u7684RCT\uff08\u6709\u522b\u4e8eCITRIS-ALI\u7814\u7a76\uff09\uff0c\u5982\u679c\u5168\u90e8\u6216\u5927\u591a\u6570\u5f97\u5230\u9634\u6027\u7ed3\u679c\uff0c\u771f\u7684\u5f88\u610f\u5916\u5417\uff1f<\/li>
  • \u603b\u662f\u505a\u8fd9\u4e9b\u7ed3\u679c\u6ce8\u5b9a\u4e3a\u9634\u6027\u7684\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u5c3d\u7ba1\u63d0\u4f9b\u4e86\u6240\u8c13\u5faa\u8bc1\u533b\u5b66\u9ad8\u7ea7\u522b\u8bc1\u636e\uff0c\u4f46\u662f\u771f\u7684\u6709\u76ca\u5417\uff1f<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"

    Preliminary Communication Caring for the Criticall […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17842"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17842"}],"version-history":[{"count":4,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17842\/revisions"}],"predecessor-version":[{"id":17847,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17842\/revisions\/17847"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17842"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17842"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17842"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}