Stelmasiak Marta, Bałan Barbara Joanna, Mikaszewska-Sokolewicz Małgorzata, Niewiński Grzegorz, Kosałka Katarzyna, Szczepanowska Ewelina, Słotwiński Robert
Faculty of Medical and Health Sciences, Kazimierz Pulaski University of Technology and Humanities in Radom, Poland.
Department of Immunology, Biochemistry and Nutrition, Medical University of Warsaw, Warsaw, Poland.
Cent Eur J Immunol. 2021;46(1):82-91. doi: 10.5114/ceji.2021.105248. Epub 2021 Apr 18.
Patients treated in intensive care units (ICUs) are at high risk of malnutrition and the resulting homeostasis, metabolic, histological and immunological disorders, especially leading to organ failure and increased susceptibility to infection. In 163 patients with malnutrition [mild in 33 (19.6%), moderate in 69 (42.9%), severe in 61 (37.4%)] treated in the ICU, changes in the concentration of selected proteins [interleukin (IL)-1Ra, tumor necrosis factor (TNF-), soluble tumour necrosis factor receptor-1 (sTNFR1), IL-6, IL-10, sTLR4, MyD88, A20, HSP70, HMGB1] were examined. In the whole group of malnourished patients, median values of sTNFR1, TNF-, IL-6, TLR4, IL-1Ra were significantly increased, while the levels of MyD88 and A20 proteins were significantly reduced (in comparison to the well-nourished healthy group). Only the sTNFR1 protein showed a significant difference between mild, moderate and severe malnutrition, and increased concentrations as the severity of malnutrition increased (the correlation study found that as the degree of malnutrition increased, the sTNFR1 concentrations increased; p = 0.0000, R = 0.5442). It was observed that death was significantly more frequent in the group of patients who on the first day of hospitalization in the ICU scored 5 or more points on the NRS 2002 scale (p = 0.0004). In the patients who died significantly higher concentrations of sTNFR1, IL-6, IL-10, HSP70 were observed in comparison to the patients who survived. The present results are encouraging and indicate the desirability of undertaking multicentre clinical trials including monitoring of sTNFR1 in assessing the severity of malnutrition and immune disorders in the first hours after admission to the ICU, because it can be assumed that without early diagnosis of innate immunity disorders any attempts at their modulation may be ineffective.
在重症监护病房（ICU）接受治疗的患者面临着营养不良以及由此引发的内环境稳态、代谢、组织学和免疫紊乱的高风险，尤其会导致器官衰竭和感染易感性增加。在163例在ICU接受治疗的营养不良患者中[轻度33例（19.6%），中度69例（42.9%），重度61例（37.4%）]，检测了所选蛋白质[白细胞介素（IL）-1Ra、肿瘤坏死因子（TNF-）、可溶性肿瘤坏死因子受体-1（sTNFR1）、IL-6、IL-10、sTLR4、MyD88、A20、HSP70、HMGB1]浓度的变化。在整个营养不良患者组中，sTNFR1、TNF-、IL-6、TLR4、IL-1Ra的中位数显著升高，而MyD88和A20蛋白水平显著降低（与营养良好的健康组相比）。只有sTNFR1蛋白在轻度、中度和重度营养不良之间存在显著差异，且随着营养不良严重程度的增加浓度升高（相关性研究发现，随着营养不良程度的增加，sTNFR1浓度升高；p = 0.0000，R = 0.5442）。观察到在ICU住院第一天NRS 2002量表得分5分或更高的患者组中死亡明显更频繁（p = 0.0004）。与存活患者相比，死亡患者中sTNFR1、IL-6、IL-10、HSP70的浓度明显更高。目前的结果令人鼓舞，表明有必要开展多中心临床试验，包括在入住ICU后的最初数小时内监测sTNFR1以评估营养不良和免疫紊乱的严重程度，因为可以假定，如果不早期诊断先天性免疫紊乱，任何调节这些紊乱的尝试可能都是无效的。
