Chung Hangyul M, Cartwright Megan M, Bortz David M, Jackson Trachette L, Younger John G
Department of Emergency Medicine and Center for Computational Medicine and Biology, University of Michigan, Ann Arbor, Michigan, USA.
Shock. 2008 Nov;30(5):518-26. doi: 10.1097/SHK.0b013e31816a0b77.
Unlike many localized infections, the development and resolution of bacteremia involves physical and immunological interactions between many anatomic sites. In an effort to better understand these interactions, we developed a computational model of bacteremia as a dynamical system fashioned after multicompartmental pharmacodynamic models, incorporating bacterial proliferation and clearance in the blood, liver, spleen, and lungs, and the transport of pathogens between these sites. A system of four first-order homogeneous ODEs was developed. Blood and organ bacterial burdens were measured at various time points from 3 to 48 h postinoculation using an LD25 murine model of Staphylococcus epidermidis bacteremia. Using these empiric data, solutions to the mathematical model were recovered. A bootstrap resampling method was used to generate 95% confidence intervals around the solved parameters. The validity of the model was examined in parallel experiments using animals acutely immunocompromised with cyclophosphamide; the model captured abnormalities in bacterial partitioning previously described with this antineoplastic agent. Lastly, the approach was used to explore possible benefits to clinically observed hyperdynamic blood flow during sepsis: in simulation, normal mice, but not those treated with cyclophosphamide, enjoyed significantly more rapid bacterial clearance from the bloodstream under hyperdynamic conditions.
与许多局部感染不同,菌血症的发展和消退涉及多个解剖部位之间的物理和免疫相互作用。为了更好地理解这些相互作用,我们构建了一个菌血症计算模型,该模型是一个基于多室药效学模型构建的动态系统,纳入了血液、肝脏、脾脏和肺中细菌的增殖和清除,以及这些部位之间病原体的转运。我们建立了一个由四个一阶齐次常微分方程组成的系统。使用表皮葡萄球菌菌血症的LD25小鼠模型,在接种后3至48小时的不同时间点测量血液和器官中的细菌负荷。利用这些经验数据,得到了数学模型的解。采用自助重采样方法在求解参数周围生成95%的置信区间。在使用环磷酰胺急性免疫受损的动物的平行实验中检验了该模型的有效性;该模型捕捉到了先前用这种抗肿瘤药物描述的细菌分布异常。最后,该方法被用于探索脓毒症期间临床观察到的高动力血流可能带来的益处:在模拟中,正常小鼠在高动力条件下从血液中清除细菌的速度明显更快,但用环磷酰胺治疗的小鼠则不然。