Karakteristike medijatora inflamacije u sistemskoj cirkulaciji kritično obolelih pacijenata sa sekundarnom sepsom porekla peritonitisa, pankreatitisa i teške traume
Đukić, Snežana, 1981-
Šurbatović, Maja, 1964-
Jevđić, Jasna, 1964-
Arsenijević, Miloš, 1983-
Stojanović, Bojana, 1988-
Stevanović, Predrag, 1959-
Uvod.Uloga imunskog odgovora u sepsi i dalje nije potpuno razjašnjena i predmet jeistraživanja. Ciljevi:Utvrditi razlike u citokinskom profilu kod kritičnoobolelih bolesnika sa sepsom porekla pankreatitisa, peritonitisa i traume u odnosuna osnovno stanje, uzročnika i proceniti prognostičku vrednost u odnosu na ishod.Metode.Uzorci krvi uzeti su od 125 bolesnika sa sepsom porekla peritonitisa,pankreatitisa i traume, iz kojih su određeni nivoi proinflamatornih: TNF-α, IL-1α,IL-1β, IFN-γ, IL-6, IL-8, IL-12r70, IL-17A, IP 10, MCP1, MIP-1α, MIP-1β i antiinflamatornih citokina: IL-33, IL-31, IL-27, IL-13, IL-10, IL-4, prvog, a potom trećegi petog dana. Rezultati. Nivoi TNF-α, MIP-1β, IL-1α, IP 10, MCP-1, IL-27, IL-33 i IL10 bili su veći u grupi peritonitisa u odnosu na pankreatitis prvog dana merenja.Poređenjem nivoa citokina između prvog, trećeg i petog dana merenja u grupiposttraumatske sepse ustanovljene su razlike za proinflamatorne: TNF-α, IL-1β, IP10, IL-8, MIP-1β, IL-17A, IFN-γ, MIP-1α, IL-1α, IL-12p70 i anti-inflamatornecitokine: IL-33, IL-10, IL-31, IL-13. Razlike u nivoima citokina u pogledubakterijemije ustanovili smo kod svih citokina, osim IL-8, trećeg dana merenja.Jedini prediktor letalnog ishoda prvog dana merenja bio je IL-17A kod bolesnika sasepsom porekla peritonitisa. Zaključci. Citokinski profil kod pacijenata sasepsom porekla peritonitisa pokazao je veće vrednosti u odnosu na pacijente sasepsom kod teškog pankreatitisa u prvom danu merenja. Najniži nivoi citokinaizmereni su kod pacijenata sa polimikrobnom hemokulturom. Niska koncentracijaIL-17A kod pacijenata sa septičkim peritonitisom predviđa smrtni ishod.
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Introduction: The role of the sepsis-related immune response has not been fully clarified,and still remains a subject matter of investigations. Objectives: to determine the differencesin the cytokine profile in critically ill patients with sepsis of pancreatitis, peritonitis andtrauma in relation to the underlying condition, the causative agent and to evaluate theprognostic value in relation to the outcome. Methods. Blood samples were taken from 125patients with sepsis of peritonitis, pancreatitis and trauma origin, from which the levels ofpro-inflammatory factors were determined:TNF-α, IL-1α, IL-1β, IFN-γ, IL-6, IL-8, IL-12p70,IL-17A, IP10, MCP-1, MIP-1α, MIP-1β and anti-inflammatory cytokines IL-33, IL-31, IL27, IL-13, IL-10, IL-4, the first, and then on the third and fifth day. Results. The levels ofTNF-α, MIP-1β, IL-1α, IP 10, MCP-1, IL-27, IL-33 and IL-10 were higher in the group ofperitonitis compared to pancreatitis on the first day of measurement. By comparing cytokinelevels between the first, third and fifth day of measurement in the post-traumatic sepsisgroup, differences were found for pro-inflammatory: TNF-α, IL-1β, IP 10, IL-8, MIP-1β, IL17A, IFN-γ, MIP-1α, IL-1α, IL-12p70 and anti-inflammatory cytokines:IL-33, IL-10, IL-31,IL-13. Differences in cytokine levels with regard to bacteremia were found for all cytokines,except for IL-8, on the third day of measurement. The only predictor of lethal outcome on thefirst day of measurement was IL-17A in patients with sepsis of peritonitis origin.Conclusions. Cytokine profile in patients with sepsis of peritonitis origin showed highervalues compared to patients with sepsis in severe pancreatitis on the first day ofmeasurement. The lowest cytokine levels were measured in patients with polymicrobial bloodcultures. Low concentration of IL-17A in patients with septic peritonitis predicts fataloutcome.
srpski
2024
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