Periplaneta americana extract used in patients with systemic inflammatory response syndrome

BACKGROUND:Periplaneta americana extract is recognized to have a positive effect on gastrointestinal mucosa.This study aimed to investigate the effects of periplaneta americana extract on immune function,nutrition status and gastrointestinal complications of early enteral nutrition patients with systemic inflammatory response syndrome(SIRS).METHODS:Patients with SIRS were randomly divided into two groups:treatment and control groups.All patients in the two groups received conventional therapy including enteral nutrition,but periplaneta americana extract,an additional Chinese medicine,was given to the patients in the treatment group.At the beginning of treatment(0 day)and 1,3,and 7 days after treatment,the levels of immunoglobulin(Ig A),total lymphocyte count(TLC),total protein(TP)and prealbumin(PA)were respectively tested in patients'venous blood.The incidences of bloating,diarrhea,aspiration pneumonia and high blood sugar at 7 days after treatment were recorded.The mortality of the patients in 28 days was recorded.RESULTS:At 3 and 7 days after treatment,the levels of Ig A and TLC in the treatment group were higher than those in the control group(P<0.05).At 7 days after treatment,the levels of TP and PA in the treatment group were higher than those in the control group(P<0.05).The incidences of bloating and diarrhea in the treatment group were lower than those in the control group,the differences were significant(P<0.05).The mortality of treatment group was lower than that of the control group(P>0.05).CONCLUSION:Periplaneta americana extract could reduce gastrointestinal complications and improve immune function and nutritional status in patients with systemic inflammatory response syndrome.

Expression and Significance of Toll-like Receptor 2,4 of Peripheral Blood Mononuclear Cells in Acute Abdomen Patients Associated with Systemic Inflammatory Response Syndrome

The changes of Toll-like receptor （TLR） 2, 4 of peripheral blood mononuclear cells （PBMCs） in the acute abdomen patients associated with systemic inflammatory response syndrome （SIRS） and their potential significance were explored. A clinical study was performed on 103 acute abdomen patients in whom 65 were associated with SIRS. Forty healthy individuals served as normal controls. The mRNA expression of TLR2, 4 was detected by RT-PCR, and the expression of TNF-α and IL-6 by ELISA. The level of plasma endotoxin, hospital stay and mortality were measured. It was found that the endotoxin level was increased to varying degrees in all the acute abdomen patients, and the endotoxin level was and hospital stay longer in SIRS group than in non-SIRS group （P〈0.01）. TLR2 mRNA, TLR4 mRNA, IL-6 and TNF-ct could be detected with low value in normal controls, but they were up-regulated markedly on the 1 st day after admission. Then TLR4 mRNA, IL-6 and TNF-α were decreased gradually, but TLR2 mRNA maintained at a high level till the 5th day. These indexes above in SIRS group were higher than those in non-SIRS group （P〈0.01）. The results of correlation analysis revealed the expression of TLR2, 4 mRNA was positively correlated with the levels of TNF-α and IL-6, and the hospital stay, The results of Logistic regression demonstrated that overexpression of TLR2, 4 mRNA might result in higher risk of multiple organ dysfunction syndrome （MODS）. It was concluded that in the acute abdomen patients associated with SIRS, the expression of TLR2, 4 in PBMCs was increased markedly, suggesting that TLR might play an important role in the pathogenesis of acute abdomen associated with SIRS.

Urokinase-type plasminogen activator receptor as a predictor of poor outcome in patients with systemic inflammatory response syndrome

BACKGROUND:Urokinase-type plasminogen activator(uPA) and urokinase-type plasminogen activator receptor(uPAR) are known as important factors,which mediate a variety of functions in terms of vascular homeostasis,inflammation and tissue repair.However,their role in systemic inflammatory response syndrome(SIRS) has been less well studied.This study aimed to test the hypothesis that the abnormalities of fibrinolysis and degradation of extracellular matrix mediated by uPA and uPAR are directly related to the patients with SIRS.We therefore analyzed their role and clinicopathological significance in patients with SIRS.METHODS:A case-control study was conducted with 85 patients who were divided into two groups according to the diagnostic criteria of SIRS:SIRS group(n=50) and non-SIRS group(/7=35).The SIRS group was divided into MODS group(n=26) and non-MODS group(n=24) by their severity,and survival group(n=35) and non-survival group(n=15) by their prognosis.Another 30 healthy adults served as normal controls.uPA and uPAR in plasma were detected by commercial enzyme-linked immunosorbent assay(ELISA) kits.RESULTS:The plasma level of uPA was lower in the SIRS group than in the non-SIRS group and controls(P<0.001 and P<0.001).It was lower in sepsis patients and the MODS group than in the non-sepsis patients and the non-MODS patients(all P<0.05).However,there was no difference in uPA level between survivors and non-survivors(P>0.05).The plasma level of uPAR increased in the SIRS group compared with the non-SIRS group and controls(P<0.001 and P<0.001).There was a significant elevation of uPAR in sepsis patients,MODS patients and non-survivors as compared with non-sepsis patients,non-MODS patients and survivors respectively(all P<0.05).Plasma uPAR levels were positively correlated with APACHE Ⅱ score(r=0.575,P<0.001) and SOFA score(r=0.349,P=0.013).AUCs for the prediction of SIRS mortality were 0.67 and 0.51,respectively,for uPA and uPAR.CONCLUSION:uPAR could be a predictor of poor outcome in patients with SIRS.

Prognostic significance of urokinase-type plasminogen activator and its receptor in patients with systemic inflammatory response syndrome

BACKGROUND： This study aimed to determine the plasma levels of urokinase-type plasminogen activator （uPA）, urokinase-type plasminogen activator receptor （uPAR）, D-dimer, IL-6 and TNF-α, and observe the relations among uPA, uPAR, D-dimer, IL-6 and TNF-α in patients with systemic inflammatory response syndrome （SIRS）.METHODS： A prospective, clinical case-control study was conducted in patients with SIRS at age of more than 55 years old treated during 2008-2010 at Wuhan Central Hospital. Venous blood samples were collected by routine venipuncture. Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS： SIRS patients from intensive care units （n=50）, and non- SIRS patients from medical wards （n=35）. Thirty healthy blood donors who visited the General Health Check-up Division at Wuhan Central Hospital served as controls. Excluded from the study were （1） those patients with pregnancy; （2） those with cancer; （3） those died after admission into the ICU in 7 days; （4） those received cardiopulmonary resuscitation; （5） those who had previous blood system diseases; and （6） those with SIRS before admission into the ICU. The levels of uPA, uPAR, D-D, IL-6 and TNF-a in blood were detected by commercial enzyme-linked immunosorbent assay （ELISA） kit. The data were analyzed using SPSS version 17.0 and expressed as mean ＋ standard. Student＇s t test and the Mann-Whitney U test were used in the analysis. The relations of uPA, uPAR and D-dimer, IL-6 TNF-α levels were analyzed using Spearman＇s rank-order correlation coefficient test. RESULTS： The plasma levels of uPA, uPAR, D-dimer, lL-6 and TNF-α in the patients with SIRS were obviously higher than those in the non-SIRS patients and controls （P〈0.001）. Correlation analysis showed a positive correlation between uPAR and IL-6 levels （r=0.395, P=0.004） and between uPAR and TNF-a levels （r=0.606, P〈0.001）, but no correlation between uPAR and D-dimer levels （r=0.069, P=0.632）. No correlation was observed between uPA, D-dimer, IL-6 and TNF-α levels （P〉0.05）. The establishment of ROC curve was based on the levels of uPAR, D-dimer, IL-6 and TNF-α in 24 hours for the diagnosis of multiple organ dysfunction syndrome （MODS）, and the ROC areas under the curve were 0.76, 0.58, 0.86 and 0.83, respectively. CONCLUSIONS：uPA and uPAR play a major role in patients with SIRS in the process of coagulation disorder, but the mechanism of SIRS is not the same. uPAR may play a central role in the development of SIRS to MODS.

Effects of internal iliac artery embolization on systemic inflammatory response syndrome in dogs with simulatedpelvic-fracture combined with massive bleeding

Background: Pelvic fracture combined with massive bleeding(PFCMB) is a complex issue in clinical practice. Currently, the use of angiography and embolization for the treatment of PFCMB obtains good results. The aim of this study is to observe the effects of early internal iliac artery embolization on the systemic inflammatory response syndrome(SIRS) in dogs with simulated-pelvic-fracture combined with massive bleeding.Methods: Twenty adult dogs were randomly divided into an embolization group(EG) and a control group(CG). For the two groups, heart rate, respiratory rate and body temperature and other physiological variables were measured, and IL-6, TNF-α and arterial blood gas levels were monitored. These variables were assayed every 30 min until death in the CG, while dogs in the EG underwent arterial angiography after 60 min of modeling. The internal iliac artery was embolized on the injured side.Results: The average time to SIRS in the CG was 3.56 h, occurring at a rate of 90%(9/10) within 24 h, with a mortality rate of 50%(5/10); the average time to SIRS for the EG was 5.33 h, occurring at a rate of 30%(3/10) within 24 h, with a mortality rate of 10%(1/10). When SIRS occurred in the EG, the mean plasma IL-6 level was 52.66±7.38pg/ml and the TNF-ps, tα level was 11.45±2.72ng/ml, showing a significant difference with those of the CG(P<0.05). In the two grouhe respiratory rate and leukocyte levels were higher at each monitored time after modeling than those before modeling; the mean arterial pressure, levels of hemoglobin and oxygen partial pressure were significantly lower at each time point after modeling than those before modeling except for the mean arterial pressure at 0h in EG; the platelet levels at 4 and 8h were higher than those before modeling; and the differences were statistically significant(P<0.05). In the EG, the mean arterial pressure, heart rate, respiratory rate and hemoglobin levels at 2, 4 and 8h were lower than those at 0h; the levels of leukocytes, platelets and carbon dioxide partial pressure at 4 and 8h after modeling were higher than those at 0h, and the differences were statistically significant(P<0.05, P<0.01); in the CG after modeling, the mean arterial pressure, levels of hemoglobin and carbon dioxide partial pressure at 2, 4 and 8h were lower than those at 0h; the levels of heart rate and leukocytes were higher than those before modeling; the respiratory rate and platelet levels at 4 and 8h were higher than those at 0h; and the differences were statistically significant(P<0.05). The levels of the mean arterial pressure and hemoglobin at 4 and 8h and the p H values at 8h after modeling in the EG were significantly higher than those in the CG, while the heart rate and respiratory rate at 4 and 8h were significantly lower than those in the CG. The p H values at 8h after modeling were significantly lower than those of the other monitored times in the CG(P<0.05, P<0.01). The two groups had elevated levels of alkaline phosphatase after injury induction.Conclusion: Through the use of an on-spot interventional treatment cabin, early internal iliac artery embolization can control bleeding associated with pelvic fractures, delay the occurrence of SIRS, and improve the success rate of the treatment of pelvic fracture combined with bleeding.

Severity of Symptoms of Systemic Inflammatory Response Syndrome and Congestive Heart Failure Caused by Chronic Aortic Stenosis and Its Pharmacological Correction

Systemic inflammatory response syndrome (SIRS) is one of the key accompanied states that worsens severity of congestive heart failure (CHF) and leads refractory CHF to conventional therapy. We investigated whether the cessation of the symptoms and signs of SIRS prevents the progression of the CHF caused by chronic aortic stenosis in rabbits. 8 weeks after induced CHF by left descending coronary artery stenosis, all animals were randomly assigned into 3 groups: control (CG)—without therapy (infusion of 0.9% NaCl);main I— receive mg/kg of Adenocin&reg;dissolved in water for injection i.v., once daily and main II—animals receive 0.25 mg/kg enalapril i.m, furosemide 1.0 mg/kg i.v. (bolus) and pimobendan 0.1 mg/kg i.v. once daily. All animals were euthanized after 14 days of the beginning of treatment. Long-term aortic stenosis leads to a simultaneously developing of CHF, diagnosed by developing cardiac hypertrophy, increased level of BNP and myocardial oedema and SIRS, confirmed by increasing markers and symptoms of endotoxemia, tissue dysoxia and decreasing reserve ability of intrinsic defense systems. Restoration of myocardium redox-potential and level of NAD under treatment with Adenocin&reg;leads unlike combined treatment with enalapril, furosemide and pimobendan to restoration, the regulatory pathways of TNF-α synthesis, cessation of the hypoxic/ischemic, lysosomal dysfunction and free radical-induced damage in myocardium and symptoms of CHF. Potential important link between cellular metabolism (hypoxia/ischemia), endotoxemia and disturbances in intrinsic defense system is the level of redox-potentail, NAD/NADH in myocardium. Influence of oxidized form of NAD-containing positive inotropic drug Adenocin&reg;leads to the decreasing symptoms of CHF and beneficial action occurs on all the key links of SIRS.

Shock index of patients with sepsis after continuous blood purification treatment and its relationship with systemic inflammatory response syndrome and immune response

Objective:To study the shock index of patients with sepsis after continuous blood purification (CBP) treatment and its relationship with systemic inflammatory response syndrome and immune response.Methods:A total of 88 patients with sepsis who underwent continuous blood purification treatment in our hospital between June 2012 and May 2016 were chosen as research subjects, shock index (SI) was compared before and after the treatment, and according to the level of SI after treatment, all patients were divided into shock group (n=27) with SI>0.5 points and no shock group (n=61) with SI≤0.5 points. Serum contents of inflammatory mediators, Th1/Th2 cellular immunity indexes, immunoglobulin and complement were compared between two groups of patients after treatment.Results: The level of SI in patients with sepsis was significantly lower than that before treatment. Serum contents of inflammatory mediators PCT, CRP and HMGB1 in no shock group were lower than those in shock group, contents of Th1 cytokines IL-2 and IFN-γ were higher than those in shock group, contents of Th2 cytokines IL-10 and IL-13 were lower than those in shock group, and contents of IgG, IgM, IgA, C3 and C4 were higher than those in shock group.Conclusion: The level of SI decreases in the patients with sepsis after CBP treatment, and SI level is directly correlated with the systemic inflammatory response syndrome and immune response levels.

The expression of toll-like receptor 2, 4 of livers in mice with systemic inflammatory response syndrome

BACKGROUND: The complicated pathogenesis of systemic inflammatory response syndrome (SIRS) is a hot topic in critical care medicine. In this study we explored the expression of toll-like receptor (TLR) 2, 4 of livers in SIRS mice and evaluated the role of TLR2, 4 in the pathogenesis of SIRS. METHODS: Forty BABL/C mice were randomly divided into 2 groups: control (n=20) and SIRS (n=20). SIRS model was induced by severe acute pancreatitis. Blood routine, blood amylase, glutamic pyruvic transaminase and temperature were measured. Histological changes of pancreases and livers were observed microscopically. The mRNA expressions of TLR2, 4 were detected by real-time polymerase chain reaction (PCR). The protein expressions of TLR2, 4 were examined by Western blot. RESULTS: Marked edema, inflammatory cell infiltration, hemorrhage, and necrosis were observed in the pancreases and livers of SIRS mice. The concentrations of amylase and glutamic pyruvic transaminase were increased significantly. Body temperature and white blood cell count were decreased. The mRNA and protein expressions of TLR2, 4 increased markedly in SIRS mice. Significant difference was observed between SIRS and control mice (P【0.01). CONCLUSION: The expressions of TLR2, 4 of livers were increased markedly in SIRS mice, indicating that TLR might play an important role in the pathogenesis of SIRS.

Integrated systemic inflammatory response syndrome epidemic model in scale-free networks

Based on the scale-free network, an integrated systemic inflammatory response syndrome model with artificial immunity, a feedback mechanism, crowd density and the moving activities of an individual can be built. The effects of these factors on the spreading process are investigated through the model. The research results show that the artificial immunity can reduce the stable infection ratio and enhance the spreading threshold of the system. The feedback mechanism can only reduce the stable infection ratio of system, but cannot affect the spreading threshold of the system. The bigger the crowd density is, the higher the infection ratio of the system is and the smaller the spreading threshold is. In addition, the simulations show that the individual movement can enhance the stable infection ratio of the system only under the condition that the spreading rate is high, however, individual movement will reduce the stable infection ratio of the system.

Role of E. coli DNA in systemic inflammatory response syndrome

Objective: To investigate whether bacterial DNA involving in the pathogenesis of systemic inflammatory response syndrome (SIRS) and possible mechanism. Methods: Escherichia coli DNA (EC DNA) was extracted from Escherichia coli 25922 with alkaline lysis method. The mice mortality was observed after EC DNA was injected into mice via caudal vein. The changes of serum TNF-α and IL-6 levels in rats were measured with ELISA after rats were given EC DNA. Calf thymus DNA and lipopolysaccharide (LPS) were used as the control, respectively. Results: EC DNA led mice to death with notable dose-effect relationship (LD50=11.51 mg/kg), but CT DNA didn't. The peak level of TNF-αwas lower in EC DNA group than in LPS group (P＜0. 05), though the former reaching the peak I h earlier than the latter. However, they had coordinate ability to induce IL-6 release in rats, and no significant difference was seen in serum IL-6 peak level between 2 groups. Conclusion: EC DNA leads mice to death, and induces the increases of serum TNF-αand IL-6 levels in rats. EC DNA has the effect equal to LPS in inducing SIRS by triggering cytokines cascade.

Clinical application of procalcitonin combined with interleukin-6 in the diagnosis of systemic inflammatory response syndrome

Objective:To investigate the clinical application value of procalcitonin(PCT) combined with interleukin-6(IL-6) in the diagnosis of systemic inflammatory response syndrome(SIRS). Methods: 115 cases of SIRS patients were divided into sepsis group(n=46) and non-infectious SIRS group(n=69). The serum levels of PCT, IL-6 were detected within 24 h of admission in two groups. White blood cell count (WBC), neutrophil counts (N), neutrophil percentage (N %), C - reactive protein (CRP) and acute physiology and chronic health evaluation (APACHEⅡ score), sequential organ failure score (SOFA score) were recorded.Results:APACHEⅡscore, SOFA score, hospital mortality had statistical differences between sepsis group and noninfectious SIRS group (P < 0.05). The serum levels of CRP、PCT、IL-6 and N% in sepsis group were higher than those in noninfectious SIRS group(P<0.05). PCT and IL - 6 were positively correlated with APACHEⅡ scores (r = 0.580, 0.463), N, N %, PCT, IL - 6 were positively correlated with SOFA scores (r = 0.371, 0.393, 0.371, 0.393), PCT was positively related with hospital mortality (r = 0.349). ROC curve analysis showed that compared with CRP, N, N% and other inflammatory markers, the AUC of PCT, il-6 and infection score was larger, and the value of diagnosis was higher.Conclusion:The combined detection of PCT and IL-6 is more effective than single detection in prognosis of sepsis.

Expression and significance of toll-like receptor 2,4 in peripheral blood mononuclear cells in patients with systemic inflammatory response syndrome

To explore changes of toll-like receptor (TLR) 2,4 in peripheral blood mononuclear cells (PBMC) in acute abdomen patients with systemic inflammatory response syndrome (SIRS) and their significance.Methods A clinical study was done on 103 patients of which 65 were with SIRS.The mRNA expression of TLR2,4 were detected by RT-PCR;the expression of TNF-α and IL-6 were observed by ELISA;the correlation between TLR2,4 mRNA,the level of TNF-α and IL-6,and the clinical course was evaluated.Results TLR2 mRNA ,TNF-α and IL-6 were upregulated markedly on the first day of hospitalization,then decreased gradually;TLR2 mRNA maintained on high level till the 5th day.The expression of TLR2,4 mRNA was positive correlated with the level of TNF-α and IL-6,and the length of stay.TLR2,4 mRNA expression increased in patients with multiple organ failure.Conclusion In actue abdomen patients with SIRS,the expression of TLR2,4 of PBMC increased markedly,indicating its improtant role in the pathogenesis of SIRS.4 refs,2 figs,2 tabs.

微通道经皮肾镜取石手术对输尿管上段结石患者的应用效果及SIRS发生率的影响

目的研讨微通道经皮肾镜取石手术(Microchannel Percutaneous Nephrolithotomy,mPCNL)对输尿管上段结石患者的应用效果及全身炎症反应综合征(Systemic Inflammatory Response Syndrome,SIRS)发生率的影响。方法随机选取2019年8月-2022年12月厦门市中医院泌尿外科收治的100例输尿管上段结石患者为研究对象,按其入院时间顺序分组,对照组(50例)行输尿管镜钬激光碎石术(Ureteroscopic Holmium Laser Lithotripsy,URL),观察组(50例)行mPCNL术,对比两组手术基础指标、血流动力学、结石清除情况、SIRS以及术后狭窄发生情况。结果观察组手术时间较对照组长,差异有统计学意义(P<0.05);但其余手术基础指标两组对比较接近,差异无统计学意义(P均>0.05)。两组手术前后的血流动力学指标对比较接近,差异无统计学意义(P>0.05)。观察组一次性清石率(96.00%)高于对照组(82.00%),差异有统计学意义(χ^(2)=5.005,P<0.05);而SIRS以及术后狭窄发生率对比较接近,差异无统计学意义(P均>0.05)。结论mPCNL术用于输尿管上段结石的处理时间较长,但一次性清石率较高,对患者的血流动力学、术后恢复影响较小,且不增加术后SIRS及狭窄的发生风险。

ESR、CRP和COX-2对骨科创伤术后感染诊断价值及与SIRS相关性

目的探究血清红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、环氧合酶-2(cycloxygenase-2,COX-2)指标水平对骨科开放性损伤患者术后感染诊断价值与全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)评分的相关性。方法选取中国人民武装警察部队重庆市总队医院骨科2019年7月至2022年7月诊治的98例骨科开放性损伤患者作为研究对象,根据患者术后是否感染分为感染组和未感染组。感染组43例,男25例,女18例;年龄21~65岁,平均(56.19±4.33)岁。未感染组55例,男29例,女26例;年龄21~66岁,平均(56.37±4.49)岁。采用双抗体酶联免疫吸附剂测定(enzyme linked immuno sorbent assay,ELISA)检测患者血清ESR、CRP和COX-2水平;对患者行常规血液检查和生命体征的监测,计算SIRS评分;对比两组ESR、CRP和COX-2水平;分析血清ESR、CRP和COX-2对骨科创伤患者术后感染诊断价值;对比骨科创伤感染组和未感染组手术前后SIRS评分差异;Pearson分析ESR、CRP和COX-2与SIRS评分相关性。结果术后两组ESR、CRP和COX-2水平均升高,且感染组表达明显高于未感染组(P<0.05);ESR、CRP和COX-2联合检测在骨科术后感染患者中诊断评估中的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)为0.899,具有较高的特异性以及敏感度,显著高于单独ESR、CRP检测,且联合诊断对骨科术后感染患者具有高度一致性(P<0.05);术后3 d两组SIRS评分均升高,且感染组评分明显高于未感染组(P<0.05);Pearson分析骨折术后感染患者ESR、CRP和COX-2与SIRS评分相关性,发现均与SIRS评分存在显著正相关(P<0.001)。结论血清ESR、CRP和COX-2在骨科术后感染患者中呈现高表达,联合检测对患者感染发生诊断价值较高;且血清ESR、CRP和COX-2与SIRS评分呈现显著正相关,临床可对患者实行指标及时检测,以降低术后感染的发生率。

六西格玛DMAIC模型结合中医综合疗法在SAP患者SIRS管理方案中的应用研究

目的:探讨以全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)为特征的重症急性胰腺炎(severe acute pancreatitis,SAP)患者应用六西格玛DMAIC模型结合中医综合疗法的临床价值。方法:以确诊为SAP的126例患者为研究对象,采用同期奇、偶数方法分为对照组和六西格玛组各63例,对照组采用西医常规治疗,六西格玛组在对照组基础上采用六西格玛DMAIC模型结合中医综合疗法的SIRS管理方案。观察两组患者血清C反应蛋白(C-reaction protein,CRP)、白细胞介素6(interleukin-6,IL-6)和降钙素原(procalcitonin,PCT)水平以及体温、心率、呼吸、白细胞水平与中医证候积分、临床疗效。结果:与对照组干预后比较,六西格玛组患者血清CRP、IL-6和PCT水平降低(P<0.05),患者体温、心率、呼吸、白细胞水平降低(P<0.05),中医证候(发热、口渴、腹痛、舌苔黄腻及总分)积分降低(P<0.05)。六西格玛组总疗效优于对照组(P<0.05)。结论:六西格玛DMAIC模型结合中医综合疗法能够有效抑制SAP患者炎症反应,改善中医证候,提高临床疗效。

PCNL术后发生SIRS的危险因素分析

目的:探讨经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)术后发生全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的危险因素,为制订防治SIRS发生的方案提供参考。方法:回顾性分析2019年1月—2020年12月于南通大学附属常熟医院行PCNL 97例患者的临床资料。根据术后是否出现SIRS,分为SIRS组和非SIRS组。比较两组患者性别、年龄、BMI、高血压病、糖尿病、术前尿WBC、肾周脂肪条索影(perirenal fat stranding,PFS)、结石长径、手术通道、手术时间的差异。使用多因素Logistic回归分析SIRS发生的危险因素。结果:两组患者性别、年龄、BMI、高血压病、糖尿病、结石长径、手术通道、手术时间差异均无统计学意义(均P>0.05);术前尿WBC、PFS差异有统计学意义(P<0.05)。纳入BMI、糖尿病、术前尿WBC、PFS、手术通道和手术时间行多因素Logistic回归分析显示,术前尿WBC阳性、存在PFS是SIRS发生的独立危险因素(P<0.05)。结论:PCNL术后发生SIRS和术前尿WBC阳性、存在PFS相关,关注术前尿WBC和PFS,必要时给予充分的抗感染治疗可能是减少SIRS发生的重要措施。

血清NSE、维生素K_(1)与SIRS新生儿病情严重程度的相关性及对凝血功能异常的评估价值

目的研究血清神经元特异性烯醇化酶(NSE)、维生素K_(1)与全身炎症反应综合征(SIRS)新生儿病情严重程度的相关性及对凝血功能异常的评估价值。方法选取2019年1月至2021年12月河北北方学院附属第一医院收治的147例SIRS新生儿为研究对象(研究组),另选取80例同期足月健康新生儿为对照组。根据SIRS新生儿病情严重程度,将研究组分为非危重组(60例)、危重组(48例)和极危重组(39例),检测所有患儿的血清NSE、维生素K_(1)水平。采用Spearman相关性分析分析血清NSE、维生素K_(1)水平与SIRS新生儿病情严重程度的相关性。同时,根据患儿凝血功能是否正常将研究组分为正常组(43例)和异常组(104例),采用单因素分析影响SIRS新生儿凝血功能异常的相关因素,Logistic回归分析影响SIRS新生儿凝血功能异常的危险因素,并绘制受试者工作特征曲线(ROC曲线)分析血清NSE、维生素K_(1)水平对SIRS新生儿凝血功能异常的评估价值。结果研究组患儿的血清NSE水平高于对照组[(34.0±4.6)μg/L比(15.5±3.2)μg/L](P<0.01),血清维生素K_(1)水平低于对照组[(0.14±0.04)μg/L比(0.26±0.06)μg/L](P<0.01)。非危重组、危重组、极危重组的血清NSE、维生素K_(1)水平比较差异有统计学意义(P<0.01);与非危重组相比,极危重组和危重组患儿的血清NSE水平升高[(43.9±3.4)μg/L、(35.6±4.2)μg/L比(26.4±3.3)μg/L](P<0.05),且极危重组高于危重组(P<0.05);与非危重组比较,极危重组和危重组患儿的血清维生素K_(1)水平降低[(0.078±0.021)μg/L、(0.145±0.031)μg/L比(0.183±0.042)μg/L](P<0.05),且极危重组低于危重组(P<0.05)。Spearman相关性分析显示,血清NSE水平与SIRS新生儿病情严重程度呈正相关(r=0.523,P<0.001),血清维生素K_(1)水平与SIRS新生儿病情严重程度呈负相关(r=-0.489,P<0.001)。凝血功能异常组胎膜早破、小于胎龄儿、剖宫产、出生窒息占比和血清NSE水平高于凝血功能正常组(P<0.05或P<0.01),血清维生素K_(1)水平低于凝血功能正常组(P<0.01)。Logistic回归分析显示,胎膜早破、出生窒息和血清NSE、维生素K_(1)水平均是SIRS新生儿凝血功能异常的影响因素(P<0.05或P<0.01)。ROC曲线显示,血清NSE联合维生素K_(1)检查预测SIRS新生儿凝血功能异常的曲线下面积、灵敏度分别为0.826、92.37%,均高于血清NSE、维生素K_(1)水平单独预测(P<0.05)。结论血清NSE、维生素K_(1)水平在SIRS新生儿体内异常表达,其表达水平与病情严重程度关系密切,是影响此类患儿凝血功能异常的危险因素,两者联合检测能较好地预测此类患儿凝血功能异常的发生风险。

连续性血液净化治疗对慢性肾衰竭合并SIRS患者炎症指标、肾功能及免疫功能的影响

目的 探讨连续性血液净化治疗对慢性肾衰竭合并全身炎症反应综合征(SIRS)患者炎症指标、肾功能及免疫功能的影响。方法 回顾性分析2019年1月至2022年1月于榆林市第一医院治疗的85例慢性肾衰竭合并SIRS患者的临床资料,按照治疗方法不同分为对照组(n=41,基础治疗)和研究组(n=44,连续性血液净化治疗)。比较两组患者治疗前后的炎症指标[白介素-6 (IL-6)、降钙素原(PCT)、肿瘤坏死因子-α (TNF-α)]、肾功能[血肌酐(Cr)、尿素氮(BUN)、碱酯酶(CHE)]、免疫功能(CD3^(+)、CD4^(+)、CD8^(+))水平。结果 治疗后,两组患者的IL-6、PCT、TNF-α水平均显著下降,且治疗后研究组患者的IL-6、PCT、TNF-α水平分别为(32.26±5.28) ng/L、(1.01±0.29) ng/L、(7.64±2.66) ng/mL,明显低于对照组的(46.39±4.17) ng/L、(2.81±0.82) ng/L、(12.69±3.58) ng/mL,差异均有统计学意义(P<0.05);治疗后,两组患者的Cr、BUN水平均明显下降,而CHE均明显上升,且治疗后研究组患者的Cr、BUN水平分别为(343.69±82.09)μmol/L、(17.64±4.41)μmol/L,明显低于对照组的(496.38±90.68)μmol/L、(26.48±4.29)μmol/L,CHE水平为(5 025.63±443.56) U/L,明显高于对照组的(3 259.58±320.47) U/L,差异均有统计学意义(P<0.05);两组患者治疗后的CD3^(+)、CD4^(+)水平明显上升,CD8^(+)明显下降,且治疗后研究组患者的CD3^(+)、CD4^(+)水平分别为(69.38±2.95)%、(48.68±4.29)%,明显高于对照组的(61.35±2.63)%、(40.26±3.57)%,CD8^(+)水平为(25.36±3.61)%,明显低于对照组的(28.68±3.27)%,差异均有统计学意义(P<0.05)。结论 连续性血液净化治疗可有效改善慢性肾衰竭合并SIRS患者的炎症指标、肾功能及免疫功能,具有临床应用价值。

非轻症急性胰腺炎患者感染性胰腺坏死发生危险因素及与SIRS的关系研究

目的 探讨非轻症急性胰腺炎患者感染性胰腺坏死发生危险因素及与全身炎症反应综合征(SIRS)的关系,旨在为感染性胰腺坏死早期预测及早期干预提供更多参考.方法 回顾性纳入我院2016年1月~2021年6月收治非轻症急性胰腺炎患者共283例,根据是否出现感染性胰腺坏死分为无坏死组(222例)和坏死组(61例);比较两组临床特征资料,采用Logistic回归模型评估非轻症急性胰腺炎患者感染性胰腺坏死发生独立危险因素,描绘受试者工作特征(ROC)曲线评价上述危险因素用于感染性胰腺坏死发生风险临床预测效能.结果 坏死组急性生理与慢性健康(APACHE)Ⅱ评分、降钙素原水平、合并胰腺外感染比例、机械通气比例及合并SIRS比例均显著高于无坏死组(P<0.05);坏死组SIRS持续时间比例显著长于无坏死组(P<0.05);Logistic回归模型多因素分析结果显示,高APACHE Ⅱ评分、存在SIRS及长SIRS持续时间均是非轻症急性胰腺炎患者感染性胰腺坏死发生独立危险因素(P<0.05);ROC曲线分析结果显示,APACHE Ⅱ评分、是否存在SIRS及SIRS持续时间均可用于非轻症急性胰腺炎患者感染性胰腺坏死发生风险预测,其中SIRS持续时间单独预测效能最佳,同时三者联合预测效能优于各单一指标(P<0.05).结论 非轻症急性胰腺炎患者感染性胰腺坏死发生除与APACHE Ⅱ评分有关外,还受是否存在SIRS及SIRS持续时间独立影响;同时SIRS持续时间可准确用于感染性胰腺坏死发生风险预测,预测效能仅次于三种指标联合.

Relation or Influence of RVOTO in the Inflammatory Response to Reoxygenation in Patients with Tetralogy of Fallot

Background:This study evaluated differential inflammatory response to cardiopulmonary bypass reoxygenation in tetralogy of Fallot repair.Methods:We performed a retrospective study at a cardiovascular center from 2012 to 2018,including 500 patients aged 1 week–18 years who received complete repair of tetralogy of Fallot.Patients were grouped according to tertiles of preoperative RVOT gradient on echocardiography into mild,moderate,and severe stenosis.We measured the highest perfusate oxygenation(PpO_(2))during aortic occlusion as independent variable.Primary outcome was systemic inflammatory response syndrome(SIRS)within 7 days postoperatively or the time of death or discharge.Results:Overall,rate of SIRS was 24.2% without significant differences among three groups(P>0.05).Older age,male,and smaller indexed left ventricular end-diastolic volume is independent risk factor of SIRS.There were significant interactions between RVOT stenosis and PpO2 on SIRS(P interaction=0.011):higher PpO_(2) was associated with a greater SIRS risk among combined moderate and severe stenotic children(OR 1.46395%CI[1.080,1.981]per-SD increase,P=0.014)but not among mild stenotic children(OR 0.900[0.608,1.333]per-SD increase;P=0.600),independent of covariates.Conclusion:The association of PpO_(2) with SIRS was modified by RVOT obstruction severity in tetralogy of Fallot repair.