Galstian G M, Berkovskiĭ A L, Zueva V A, Kariakin A V, Levina A A, Sergeeva E V, Speranskaia L L, Gorodetskiĭ V M
Ter Arkh. 2002;74(7):56-61.
To study changes in proinflammatory markers and mediators in septic shock in patients with hematologic malignancy (HM).
The examination of 33 patients with HM and septic shock included measurement of plasma concentrations of tumor necrosis factor (TNF), interleukine-6 (IL-6), endotoxin, procalcitonin (PCT) 12-24 hours before and each 12 hours after shock; registration of central hemodynamics parameters, the condition severity by APACHE II.
Out of 33 patients 18 died of refractory shock, 15 survived the shock. Within the first shock hour TNF fell from 571.2 +/- 195 to 115.8 +/- 71.1 pg/ml (p < 0.02), later being stable. In those who died and survived TNF was the same. IL-6 fall was seen 36 hours after shock and was observed in the survivors; in those who died IL-6 was unchanged. Endotoxin in the blood was detected in 21 of 33 patients. In the survivors endotoxinemia declined after 2 days of treatment. 72 hours after beginning of the shock the survivors had no endotoxin. In shock APACH II severity of the patient's condition was graver in patients with endotoxinemia than without it (31.6 +/- 1.6 and 28.1 +/- 1.6 scores, p < 0.05). Blood endotoxin levels and APACHE II scores correlated (r = 0.24, p < 0.05) positively and negatively with deficiency of buffer bases (r = -0.29, p < 0.05) and blood pH) r = -0.3, p < 0.05), left ventricular contractility index (r = -0.46, p < 0.01) and right ventricle (r = -0.52, p < 0.01), mean AP (r = -0.22, p < 0.03). PCT concentration was lower before shock than on its hour 1 (4.2 +/- 2.9 and 6.9 +/- 1.1 ng/ml, p < 0.05). No significant changes in PCT were found later.
PCT is a specific marker of a severe infection. Rapid elimination from the blood of TNF and IL-6 makes them inadequate in sepsis diagnosis. Endotoxinemia aggravates the patients condition. Positive LAL-test results were obtained in gram-negative and fungal infections.
研究血液系统恶性肿瘤（HM）患者感染性休克时促炎标志物和介质的变化。
对33例HM合并感染性休克患者进行检查，包括在休克前12 - 24小时及休克后每12小时测量血浆肿瘤坏死因子（TNF）、白细胞介素-6（IL-6）、内毒素、降钙素原（PCT）浓度；记录中心血流动力学参数，用急性生理与慢性健康状况评分系统II（APACHE II）评估病情严重程度。
33例患者中，18例死于难治性休克，15例休克存活。在休克后第1小时内，TNF从571.2±195降至115.8±71.1 pg/ml（p<0.02），随后保持稳定。死亡组和存活组的TNF水平相同。休克36小时后，存活组出现IL-6下降，而死亡组IL-6无变化。33例患者中有21例检测到血液内毒素。存活组在治疗2天后内毒素血症下降。休克开始72小时后，存活组无内毒素。休克时，有内毒素血症的患者APACHE II病情严重程度比无内毒素血症的患者更严重（分别为31.6±1.6分和28.1±1.6分，p<0.05）。血液内毒素水平与APACHE II评分呈正相关（r = 0.24，p<0.05），与缓冲碱缺乏（r = -0.29，p<0.05）、血液pH（r = -0.3，p<0.05）、左心室收缩力指数（r = -0.46，p<0.01）和右心室（r = -0.52，p<0.01）、平均动脉压（r = -0.22，p<0.03）呈负相关。休克前PCT浓度低于休克后第1小时（4.2±2.9和6.9±1.1 ng/ml，p<0.05）。之后未发现PCT有显著变化。
PCT是严重感染的特异性标志物。TNF和IL-6从血液中快速清除，使其在脓毒症诊断中作用不足。内毒素血症会加重患者病情。革兰阴性菌和真菌感染时鲎试剂检测结果为阳性。
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