Ashok Kumar Prashanth, Anand Usha
PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, 641004 India ; No 20 A/10, Gopalakrishnan Street, Indira Devi Apartments, T.Nagar, Chennai, 600017 India.
Department of Biochemistry, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, 641004 India ; Department of Biochemistry, Anand Diagnostic Laboratory, Bangalore, 560001 India.
Indian J Clin Biochem. 2016 Jul;31(3):310-4. doi: 10.1007/s12291-015-0525-x. Epub 2015 Oct 17.
Sepsis is associated with various metabolic derangements as a consequence of inflammatory response, ischemia and oxidative stress. Four parameters of relevance are procalcitonin (PCT), ischemia modified albumin (IMA) pH and lactate. The study was carried out to highlight the concomitant occurrence of sepsis, ischemia and lactic acidosis, all of which could have deleterious effects on organ function. 26 critically ill patients with a provisional diagnosis of sepsis were the test subjects. The control group had 25 apparently healthy volunteers. PCT, lactate and IMA were assayed. PCT was estimated on an automated analyser using electro-chemiluminescence. Lactate and pH were estimated on a blood gas analyzer. Serum IMA was estimated spectrophotometrically by Albumin Cobalt Binding Test. Statistical tools like students 't' test and Venn diagram were employed to depict the outcome of the study. All critically ill patients had significantly higher IMA levels (0.96746 ± 0.73407) as compared to the control group (0.00728 ± 0.00895) with a p value of <0.0001. The Venn diagram was used to depict the finding that all 26 test subjects had elevated levels of IMA, of which PCT was elevated in 22 and lactate in 20. Both PCT and lactate were abnormal in 17 patients. The most significant observation was that all critically ill patients, irrespective of the presence of sepsis or lactic acidosis had elevated levels of IMA which is clearly indicative of the ubiquitous presence of oxidative stress. The Venn diagram is an elegant representation of the concurrent multiple pathophysiological processes which occur in critically ill patients.
作为炎症反应、缺血和氧化应激的结果，脓毒症与各种代谢紊乱相关。四个相关参数是降钙素原（PCT）、缺血修饰白蛋白（IMA）、pH值和乳酸。开展该研究是为了突出脓毒症、缺血和乳酸酸中毒的同时发生，所有这些都可能对器官功能产生有害影响。26例初步诊断为脓毒症的重症患者作为受试对象。对照组有25名明显健康的志愿者。检测了PCT、乳酸和IMA。使用电化学发光法在自动分析仪上测定PCT。在血气分析仪上测定乳酸和pH值。通过白蛋白钴结合试验用分光光度法测定血清IMA。采用学生t检验和维恩图等统计工具来描述研究结果。与对照组（0.00728±0.00895）相比，所有重症患者的IMA水平均显著更高（0.96746±0.73407），p值<0.0001。维恩图用于描述这一发现：所有26名受试对象的IMA水平均升高，其中22例PCT升高，20例乳酸升高。17例患者的PCT和乳酸均异常。最显著的观察结果是，所有重症患者，无论是否存在脓毒症或乳酸酸中毒，IMA水平均升高，这清楚地表明氧化应激普遍存在。维恩图巧妙地展示了重症患者同时发生的多种病理生理过程。
