Эндогенная интоксикация как типовой патологический процесс была и остается одной из ключевых проблем во всех областях медицины, и, прежде всего в реаниматологии. Накопление эндогенных токсических веществ является неотъемлемым компонентом любого критического состояния и сопровождает тяжелую травму, генерализованные инфекции, деструктивные заболевания полостных органов. Утрата функции детоксикационных систем при полиорганной недостаточности влечет за собой прогрессирование эндотоксикоза и нарушение транспорта кислорода, в том числе и в самих органах детоксикации, тем самым замыкается порочный круг танатогенеза. Эндогенная интоксикация-мультидисциплинарная проблема, являющаяся областью интересов разных направлений современной медицинской науки, экспериментальной патофизиологии и биомедицинской технологии. Благодаря этому в клиническую практику внедряются новые эффективные методы эфферентного лечения критических состояний. В Научно-исследовательском институте общей реаниматологии им. В. А. Неговского РАМН (ныне ФНКЦ РР) на протяжении многих лет ведется изучение теоретических и прикладных вопросов, направленных на решение проблемы эндотоксикоза. В представленном обзоре мы постарались обобщить основные результаты деятельности Института в данном направлении. Ключевые слова: эндогенная интоксикация, эфферентное лечение; детоксикация Endogenous intoxication as a typical pathological process has always been one of the key issues in all areas of medicine, especially in intensive care. Accumulation of endogenous toxic substances is an integral component of any critical condition. It accompanies severe trauma, generalized infections and destructive diseases of the cavity organs. The loss of the function of detoxification systems in multi-organ failure causes the progression of endotoxicosis and the disruption of oxygen transport (in the organs of detoxification as well), hence closing the vicious cycle of thanatogenesis. Endogenous intoxication is a multidisciplinary problem being a matter of interest in different areas of modern medical science, experimental pathophysiology and biomedical technology. As a result new effective methods of efferent treatments of critical conditions are introduced into clinical practice. For many years theoretical and applied issues aimed at solving the problem of endotoxicosis have been the focus of studies in the V. A. Negovsky Research Institute of General Reanimatology of the Russian Academy of Medical Sciences (now the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology). In the presented review we have tried to generalize the main results of the Institute's activities in this direction.
Disorders in the erythrocyte morphology and structure of their membranes during long-term storage of erythrocyte suspension (30 days at 4°C) were studied by atomic force microscopy. The morphology and nanostructure of erythrocyte membranes, biochemical parameters, ion exchange parameters, and hemoglobin spectra were recorded. The transformation of erythrocyte morphology and destruction of their membranes were observed throughout the storage period. Irreversible forms of spheroechinocytes and their fragments formed by the end of storage. The concentrations of potassium ions and lactate in solution of the blood preservatiive increased, while pH value decreased. Hemolysis detected by the erythrocyte "leakage" effect was observed starting from days 16-23 of storage.
Objective. To assess the cystatin C (CysC) prognostic value for probability of death in patients with severe and extremely severe pneumonia associated with COVID-19.Material and methods. A single-center prospective study included 72 patients with severe and extremely severe pneumonia associated with COVID-19 undergoing treatment in the ICU of multifunctional medical center from September 2020 to October 2021. Recovered survivors (N=55) were analyzed as a Group 1, nonsurvivors (N=17) were considered as a Group 2.Results. The serum (s-CysC) and urine (u-CysC) CysC concentrations were significantly lower in Group 1 patients vs Group 2, averaging 1.31 mg/l vs 1.695 mg/l (P=0.013550), and 0.25 mg/l vs 0.94 mg/l (P=0.026308), respectively. Significant differences were also revealed in the subgroups differed by age (P=0.0094), platelet count (P=0.001), serum fibrinogen concentration (P=0.016), as well as CURB (P=0.02334), CRB-65 (P=0.032564), and SOFA (P=0.042042) scores. Therefore, s-CysC and u-CysC were statistically significant predictors of death in patients with pneumonia associated with severe and extremely severe COVID-19: 16.273 (95% CI: 2.503–105,814), P=0.003 and 1.281 (95% CI: 1.011–1.622), P=0.040, respectively. Urine and serum CysC were established as predictors of death in pneumonia associated with severe and extremely severe COVID-19, where u-CysC was defined as highly informative (ROC AUC 0.938 (95% CI: 0.867–1.000; P=0.000), with 90% sensitivity and specificity), and s-CysC — as informative (ROC AUC 0.863 (95%CI: 0.738–0.988; P=0.000) with 80% sensitivity and 72% specificity) predictive markers.Conclusion. Levels of S-CysC and u-CysC are of high prognostic significance and may contribute to identifying patients at a high risk of unfavorable outcome (death) due to pneumonia associated with severe and extremely severe COVID-19. Both S-CysC and u-CysC concentrations increasing up to 1.44 mg/l and 0.86 mg/l, respectively, were associated with high probability of death.
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