Novotny A, Emmanuel K, Bartels H, Siewert J-R, Holzmann B
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München.
Chirurg. 2005 Sep;76(9):837-44. doi: 10.1007/s00104-005-1077-z.
Sepsis is still a major cause of postoperative morbidity and mortality. Numerous biochemical indicators have been evaluated regarding their potential in predicting prognosis in sepsis. Generally, one must differentiate between indicators: those for preoperative detection of patients at risk for lethal sepsis and those for early prediction of lethal outcome of septic complications. The first include the analysis of mononuclear phagocyte interleukin (IL)-12-synthesizing capability. Reduced IL-12 levels were associated with higher lethality. Cytokine-associated gene polymorphisms such as the loss of monocyte HLA-DR expression and homozygotism for the tumor necrosis factor B2 allele have a place in preoperative risk evaluation, as they were associated with worse prognosis in sepsis. Among the most important biochemical indicators for early prediction of lethal outcome in sepsis are decreased L-selectin and elevated IL-18, IL-6, and PCT plasma concentrations. Increased nuclear factor kappaB activity in mononuclear phagocytes and elevated calcitonin gene-related protein plasma concentrations were associated with unfavourable prognosis.
脓毒症仍然是术后发病和死亡的主要原因。关于众多生化指标在预测脓毒症预后方面的潜力已进行了评估。一般来说，必须区分两类指标：一类用于术前检测有致命性脓毒症风险的患者，另一类用于早期预测脓毒症并发症的致命结局。前者包括对单核吞噬细胞白细胞介素（IL）-12合成能力的分析。IL-12水平降低与较高的致死率相关。细胞因子相关基因多态性，如单核细胞人类白细胞抗原-DR（HLA-DR）表达缺失和肿瘤坏死因子B2等位基因纯合性，在术前风险评估中具有一定作用，因为它们与脓毒症预后较差相关。在早期预测脓毒症致命结局的最重要生化指标中，有L-选择素降低以及IL-18、IL-6和降钙素原（PCT）血浆浓度升高。单核吞噬细胞中核因子κB活性增加以及降钙素基因相关蛋白血浆浓度升高与不良预后相关。
