Enterocyte injury in critically ill patients - elucidation of pathogenesis and development of novel therapeutic strategies-

2023 Fiscal Year Final Research Report

• Project/Area Number: 20K09220
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 55050:Anesthesiology-related
• Research Institution: Nagasaki University
• Principal Investigator: Sekino Motohiro 長崎大学, 病院(医学系), 准教授 (40380927)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Keywords: 小腸粘膜細胞傷害 / 腸型脂肪酸結合蛋白 / 敗血症性ショック / 心臓手術 / 末梢循環 / エンドトキシン吸着療法 / 輸液管理

Outline of Final Research Achievements

In this study, we found that factors such as prolonged duration of cardiopulmonary bypass (hypoperfusion time) and increased noradrenaline use may contribute to the development of enterocyte injury in patients undergoing cardiac surgery with cardiopulmonary bypass. Additionally, in patients with septic shock, the concomitant occurrence of enterocyte injury was significantly associated with increased fluid balance early after the start of treatment. In addition, the background of the association between peripheral hypoperfusion and decreased intestinal blood flow and intestinal ischemia suggests that improvement of peripheral hypoperfusion may lead to improved patient prognosis. In septic shock patients with peripheral hypoperfusion, endotoxin adsorption therapy was shown to significantly decrease doses of noradrenaline and vasopressin and may improve peripheral perfusion.

Free Research Field

集中治療医学、麻酔科学

Academic Significance and Societal Importance of the Research Achievements

重症患者における小腸は「the motor of critical illness」と称され、予後悪化の原因となっていると考えられてきた。しかし、小腸傷害に特異的なバイオマーカーや画像検査は臨床現場において使用不可能で、予後悪化との関連を科学的に証明することは困難であった。
本研究は、小腸粘膜細胞傷害の指標である腸型脂肪酸結合蛋白(I-FABP)を用いて、心臓外科術後患者や敗血症性ショック患者を対象に予後との関連に加え、小腸粘膜細胞傷害に関連する因子を明らかにする基礎研究となった。また、前記患者群における輸液管理における工夫や腸管血流の改善を目指した治療に関する治験を得ることができた。