rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2019-4-32-41rmt-1787Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ И ПРАКТИКАCLINICAL STUDIES AND PRACTICEСостояние иммунитета и его влияние на частоту развития полиорганной недостаточности у пациентов после операций на сердцеImmunity and Its Effect on the Incidence of Multiple Organ Failure in Patients after the Heart SurgeryПартыловаЕ. А.PartylovaE. A.

62000, г. Екатеринбург, ул. Волгоградская, д. 185

Elena A. Partylova

185 Volgogradskaya Str., 62000 Yekaterinburg

ПетрищевЮ. И.PetrishchevYu. I.

Юрий Иванович Петрищев

62000, г. Екатеринбург, ул. Волгоградская, д. 185

Yury I. Petrishchev

185 Volgogradskaya Str., 62000 Yekaterinburg

jurpetr76@rambler.ruКудрявцевИ. В.KudryavtsevI. V.

197376, г. Санкт-Петербург, ул. Академика Павлова, д. 12

Igor V. Kudryavtsev

12 Academician Pavlova Str., 197376 Saint Petersburg

МалковаО. Г.MalkovaO. G.

62000, г. Екатеринбург, ул. Волгоградская, д. 185

Olga G. Malkova

185 Volgogradskaya Str., 62000 Yekaterinburg

ЛевитА. Л.LevitA. L.

62000, г. Екатеринбург, ул. Волгоградская, д. 185

Alexander L. Levit

185 Volgogradskaya Str., 62000 Yekaterinburg

Свердловская Областная Клиническая Больница №1РоссияSverdlovsk Regional Clinical Hospital №1Russian FederationИнститут экспериментальной медицины, Первый Санкт-Петербургский государственный медицинский университет им. И. П. Павлова Минздрава РоссииРоссияExperimental Medicine Institute, I. P. Pavlov First Saint-Petersburg State Medical University, Ministry of Health of RussiaRussian Federation2019040920191543241Copyright © Партылова Е.А., Петрищев Ю.И., Кудрявцев И.В., Малкова О.Г., Левит А.Л., 20192019Партылова Е.А., Петрищев Ю.И., Кудрявцев И.В., Малкова О.Г., Левит А.Л.Partylova E.A., Petrishchev Y.I., Kudryavtsev I.V., Malkova O.G., Levit A.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1787

Цель исследования — выявить компоненты иммунитета, позволяющие предсказать развитие полиорганной недостаточности у пациентов после операций на сердце.

Материал и методы

Материал и методы. В исследование включили 40 пациентов, оперированных в плановом порядке. Критерием включения служило наличие показаний для проведения кардиохирургического вмешательства. Критерием исключения — наличие у пациентов инфекционного эндокардита. До операции и через 24 часа исследовали общий анализ крови, с подсчетом количества лейкоцитов и лимфоцитов, фенотип иммунокомпетентных клеток с использованием моноклональных антител, а также проводили количественную оценку компонентов комплемента 3 и 4, и прокальцитонина. Всем пациентам проводили оценку полиорганной недостаточности (ПОН) с использованием шкалы SOFA.

Результаты

Результаты. Результаты показали, что кардиохирургическое вмешательство приводило к развитию ПОН, статистически значимым разнонаправленным изменениям как в количественном, так и в качественном составе всех клеток иммунной системы, значимому изменению концентрации С3 и С4 компонентов каскада комплемента и плазменного содержания прокальцитонина. При проведении ROC анализа выявили, что относительное содержание моноцитов менее 7,1% от количества лейкоцитов так же, как и абсолютное содержание моноцитов с фенотипом CD14+HLA-DR+ менее 0,32_109/л в дооперационном периоде, и концентрация С3 компонента комплемента менее 0,52 г/л также, как и максимальный балл SOFA в послеоперационном периоде являлись предикторами развития ПОН в послеоперационном периоде.

Заключение

Заключение. Компоненты врожденного иммунитета позволяют раньше, чем шкала SOFA построить прогноз исхода операций на сердце.

The purpose of the study is to identify the components of immunity, which might predict the development of multiple organ failure in patients after heart surgery.

Material and methods

Material and methods. The study included 40 patients who were operated in cardiac surgery Department. The inclusion criteria were the presence of indications for cardiac surgery. The exclusion criteria were the presence of infective endocarditis in patients. Before the operation and after 24 hours we studied the blood level of leukocytes and lymphocytes. We analyzed the phenotype of immune cells using monoclonal antibodies, serum levels of procalcitonin and C3 and C4 complement components. All patients were evaluated for multiple organ disfunction (MOD) using the SOFA scale.

The results showed that cardiac surgery leads to the development of MOD, statistically significant multidirectional changes in both quantitative and qualitative composition of all cells of the immune system, significant changes in the level of C3 and C4 components of the cascade of complement and plasma level of pro-calcitonin. ROC analysis was revealed that the relative content of monocytes is less than 7.1% of the number of leukocytes as well as the absolute content of monocytes with the CD14 + HLA-DR + phenotype less than 0.32_109/l in the preoperative period, and the C3 level of the complement component less than 0.52 g/l, as well as the maximum SOFA score in the postoperative period, were the best predictors of MOD after the procedures.

Conclusion

Conclusion. The components of innate immunity make it possible to predict the complication of the cardiac surgery, earlier than the SOFA scale.

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The authors declare that there are no conflicts of interest present.