Brazhnikov Anatoly, Zotova Natalya, Solomatina Liliya, Sarapultsev Alexey, Spirin Alexey, Gusev Evgeni
Department of Anesthesiology, Resuscitation and Toxicology, Ural State Medical University, 620028 Yekaterinburg, Russia.
Institute of Immunology and Physiology Ural Branch of the Russian Academy of Sciences, 620049 Yekaterinburg, Russia.
Pathophysiology. 2023 Feb 21;30(1):48-62. doi: 10.3390/pathophysiology30010006.
Amniotic fluid embolism (AFE) is one of the main causes of maternal mortality in developed countries. The most critical AFE variants may be considered from the perspective of systemic inflammation (SI), a general pathological process that includes high levels of systemic inflammatory response, neuroendocrine system distress, microthrombosis, and multiple organ dysfunction syndrome (MODS). This research work aimed to characterize the dynamics of super-acute SI using four clinical case studies of patients with critical AFE.
In all the cases, we examined blood coagulation parameters, plasma levels of cortisol, troponin I, myoglobin, C-reactive protein, IL-6, IL-8, IL-10, and TNF-α, and calculated the integral scores.
All four patients revealed the characteristic signs of SI, including increased cytokine, myoglobin, and troponin I levels, changes in blood cortisol, and clinical manifestations of coagulopathy and MODS. At the same time, the cytokine plasma levels can be characterized not only as hypercytokinemia, and not even as a "cytokine storm", but rather as a "cytokine catastrophe" (an increase of thousands and tens of thousands of times in proinflammatory cytokine levels). AFE pathogenesis involves rapid transition from the hyperergic shock phase, with its high levels of a systemic inflammatory response over to the hypoergic shock phase, characterized by the mismatch between low systemic inflammatory response values and the patient's critical condition. In contrast to septic shock, in AFE there is a much more rapid succession of SI phases.
AFE is one of the most compelling examples for studying the dynamics of super-acute SI.
羊水栓塞（AFE）是发达国家孕产妇死亡的主要原因之一。从全身炎症（SI）的角度来看，最严重的AFE变体可能是一个普遍的病理过程，包括高水平的全身炎症反应、神经内分泌系统紊乱、微血栓形成和多器官功能障碍综合征（MODS）。本研究旨在通过对4例重症AFE患者的临床病例研究来描述超急性SI的动态变化。
在所有病例中，我们检测了凝血参数、血浆皮质醇、肌钙蛋白I、肌红蛋白、C反应蛋白、白细胞介素-6、白细胞介素-8、白细胞介素-10和肿瘤坏死因子-α水平，并计算积分。
所有4例患者均表现出SI的特征性体征，包括细胞因子、肌红蛋白和肌钙蛋白I水平升高、血皮质醇变化以及凝血病和MODS的临床表现。同时，细胞因子血浆水平不仅可被描述为高细胞因子血症，甚至不是“细胞因子风暴”，而是“细胞因子灾难”（促炎细胞因子水平增加数千倍和数万倍）。AFE的发病机制涉及从高反应性休克阶段迅速转变，该阶段全身炎症反应水平较高，转变为低反应性休克阶段，其特征是全身炎症反应值较低与患者危急状况不匹配。与脓毒性休克不同，AFE中SI阶段的相继出现要快得多。
AFE是研究超急性SI动态变化最有说服力的例子之一。
