Мониторинг иммунной системы у пациентов в критическом состоянии (обзор)

У большинства пациентов в критических состояниях, независимо от их причины, происходит активация врожденного и адаптивного иммунитета. Это зачастую является эпикритическим процессом и приводит к дисфункции органов.

Цель обзора: систематизировать для врачей различных специальностей (анестезиологов-реаниматологов, хирургов, терапевтов, акушеров-гинекологов) информацию о возможностях мониторинга иммунной системы при критических состояниях.

В обзор включили сведения из 83 современных отечественных и зарубежных публикаций (в основном работы 2023 г.), размещенных в свободном доступе и обнаруженных по ключевым словам.

Обобщили современные представления о взаимоотношениях инфекций и иммунной системы человека, клинического применения традиционных маркеров иммунного статуса. Привели данные о новых перспективных маркерах оценки состояния иммунитета у пациентов при различной патологии.

Ограничения исследований связаны с необходимостью дальнейших масштабных клинических испытаний даже самых многообещающих маркеров, а также систематизации данных о них. Кроме того, иммунный мониторинг, вероятно, увеличит стоимость лечения пациентов, в связи с чем должны развиваться менее затратные по сравнению с ним методы исследований.

Заключение. Почти все патологические нарушения организма пациентов в критических состояниях приводят к изменению иммунитета. Ведение пациентов в соответствии с их иммунным профилем ставит задачу: определить персонализированные тактики иммунной стимуляции, лечения, профилактики инфекций. Углубленный мониторинг функции иммунной системы будет способствовать персонализации медицины, а постоянный прогресс современных биологических технологий позволит усовершенствовать его методы.

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