mimmunМедицинская иммунологияMedical Immunology (Russia)1563-06252313-741XSPb RAACI10.15789/1563-0625-2014-2-173-182mimmun-683Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESЦИТОКИНОВЫЙ ОТВЕТ И ДРУГИЕ ОТЛИЧИТЕЛЬНЫЕ ОСОБЕННОСТИ КРИТИЧЕСКИХ ФАЗ СИСТЕМНОГО ВОСПАЛЕНИЯ ПРИ СЕПСИСЕCYTOKINE RESPONSE AND OTHER DIFFERENCES BETWEEN CRITICAL PHASES OF SEPSIS-ASSOCIATED SYSTEMIC INFLAMMATIONГусевЕ. Ю.GusevE. Yu.

д.м.н., профессор, заведующий лабораторией иммунологии воспаления ФГБУН «Институт иммунологии и физиологии» УрО РАН

PhD, MD (Medicine), Professor, Chief, Laboratory of Inflammation Immunology, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences

gusev36@mail.ruЗотоваН. В.ZotovaN. V.

к.б.н., старший научный сотрудник лаборатории иммунологии воспаления ФГБУН «Институт иммунологии и физиологии» УрО РАН

PhD (Biology), Senior Research Associate, Laboratory of Inflammation Immunology, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences

ЛазареваМ. А.LazarevaM. A.

врач хирургического отделения ГБУЗ СО «Свердловская областная клиническая больница № 1»

Surgeon, Department of Surgery, Sverdlovsk Regional Clinical Hospital № 1

ФГБУН «Институт иммунологии и физиологии» УрО РАН, г. ЕкатеринбургРоссияInstitute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, EkaterinburgRussian FederationГБУЗ СО «Свердловская областная клиническая больница № 1», г. ЕкатеринбургРоссияSverdlovsk Regional Clinical Hospital № 1, EkaterinburgRussian Federation201401082014162173182Copyright © Гусев Е.Ю., Зотова Н.В., Лазарева М.А., 20142014Гусев Е.Ю., Зотова Н.В., Лазарева М.А.Gusev E.Y., Zotova N.V., Lazareva M.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mimmun.ru/mimmun/article/view/683

В работе сопоставлялись острый сепсис (1-3 сутки от момента госпитализации) и третичный перитонит как вариант затяжного сепсиса (1-6 недель). Всего пациентов – 153, с полиорганной недостаточностью (шкала SOFA) – 112, из них с септическим шоком – 31, летальных исходов – 48. В плазме крови иммунохемилюминесцентным методом (Immulite) исследовали концентрации С-реактивного белка, цитокинов (IL-6, IL-8, IL-10, TNFα), кортизола, тропонина I, миоглобина, D-димеров и с помощью интегральных критериев определяли наличие системного воспаления (СВ).Выявлена связь развития СВ с критическими осложнениями в обеих группах. Однако при остромсепсисе преобладают гиперергические варианты развития процесса, связанные с высокими уровнями в крови цитокинов. Напротив, при третичном перитоните доминируют гипоергические варианты развития СВ, с относительно невысокими уровнями цитокинов, но с большей вероятностью проявления других критериев СВ и летального исхода. Таким образом, системное воспаление при остром и затяжном сепсисе реализуется по различным патогенетическим сценариям.

Acute sepsis (1-3 days after admission) has been compared with tertiary peritonitis, as a clinical variant of prolonged sepsis (7 to 42 days after admission). A total of 153 patients were enrolled into the study, including 112 cases of multiple organ dysfunction syndrome (MODS, as assessed by SOFA score), of them thirty-one with septic shock; fatal outcomes, in 48 cases. Plasma concentrations of C-reactive protein, cytokines (IL-6, IL-8, IL-10, TNFα), cortisol, troponin I, myoglobin, D-dimer were detected by means of immunochemiluminesce assay (ImmuLite). Development of systemic inflammation (SI) was evaluated by appropriate integral criteria. An association was established between SI development and critical complications in the both groups of patients. Meanwhile, hyperergic variants of SI development associated with high cytokine levels, proved to prevail in acute sepsis. On the contrary, hypoergic variants were more common in cases of tertiary peritonitis, being characterized by relatively low levels of cytokines, along with higher probability of other SI syndromes and risks of lethal outcomes. In summary, systemic inflammatory events in acute versus prolonged sepsis may proceed by different pathogenetic pathways.

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The authors declare that there are no conflicts of interest present.