Zotova N V, Chereshnev V A, Gusev E Yu
Laboratory of immunology of inflammation, Institute of immunology and physiology of UB RAS, Yekaterinburg, Russian Federation.
KCS "Experimental physiology and immunochemistry", Auto Federal State Autonomous Educational Institution of Higher Professional Education "Ural Federal University named after the first President of Russia B. N. Yeltsin", Yekaterinburg, Russian Federation.
PLoS One. 2016 May 6;11(5):e0155138. doi: 10.1371/journal.pone.0155138. eCollection 2016.
We defined Systemic inflammation (SI) as a "typical, multi-syndrome, phase-specific pathological process, developing from systemic damage and characterized by the total inflammatory reactivity of endotheliocytes, plasma and blood cell factors, connective tissue and, at the final stage, by microcirculatory disorders in vital organs and tissues." The goal of the work: to determine methodological approaches and particular methodical solutions for the problem of identification of SI as a common pathological process. SI can be defined by the presence in plasma of systemic proinflammatory cell stress products-cytokines and other inflammatory mediators, and also by the complexity of other processes signs. We have developed 2 scales: 1) The Reactivity Level scale (RL)-from 0 to 5 points: 0-normal level; RL-5 confirms systemic nature of inflammatory mediator release, and RL- 2-4 defines different degrees of event probability. 2) The SI scale, considering additional criteria along with RL, addresses more integral criteria of SI: the presence of ≥ 5 points according to the SI scale proves the high probability of SI developing. To calculate the RL scale, concentrations of 4 cytokines (IL-6, IL-8, IL-10, TNF-α) and C-reactive protein in plasma were examined. Additional criteria of the SI scale were the following: D-dimers>500ng/ml, cortisol>1380 or <100nmol/l, troponin I≥0.2ng/ml and/or myoglobin≥800ng/ml. 422 patients were included in the study with different septic (n-207) and aseptic (n-215) pathologies. In 190 cases (of 422) there were signs of SI (lethality 38.4%, n-73). In only 5 of 78 cases, lethality was not confirmed by the presence of SI. SI was registered in 100% of cases with septic shock (n-31). There were not significant differences between AU-ROC of CR, SI scale and SOFA to predict death in patients with sepsis and trauma.
我们将全身炎症(SI)定义为“一种典型的、多综合征、阶段特异性的病理过程,由全身损伤引发,其特征为内皮细胞、血浆和血细胞因子、结缔组织的整体炎症反应,在最后阶段则表现为重要器官和组织的微循环障碍”。这项工作的目标是:确定将SI识别为一种常见病理过程问题的方法学途径和具体方法学解决方案。SI可通过血浆中全身促炎细胞应激产物(细胞因子和其他炎症介质)的存在以及其他过程体征的复杂性来定义。我们制定了2个量表:1)反应水平量表(RL)——从0到5分:0为正常水平;RL - 5证实炎症介质释放的全身性,RL - 2至4定义不同程度的事件概率。2)SI量表,除RL外还考虑其他标准,涉及SI更综合的标准:根据SI量表得≥5分证明SI发生的可能性很高。为计算RL量表,检测了血浆中4种细胞因子(IL - 6、IL - 8、IL - 10、TNF - α)和C反应蛋白的浓度。SI量表的其他标准如下:D - 二聚体>500ng/ml,皮质醇>1380或<100nmol/l,肌钙蛋白I≥0.2ng/ml和/或肌红蛋白≥800ng/ml。422例患有不同败血症(n = 207)和无菌性(n = 215)疾病的患者纳入研究。422例中有190例有SI体征(致死率38.4%,n = 73)。78例中只有5例的致死率未被SI的存在所证实。败血症性休克(n = 31)的所有病例中均记录到SI。CR、SI量表和SOFA预测败血症和创伤患者死亡的AU - ROC之间无显著差异。
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