Сепсис и острое повреждение почек — дорога с двухсторонним движением: значения биомаркеров. Часть II
https://doi.org/10.33667/2078-5631-2019-3-22(397)-48-55
Аннотация
Краткий обзор, посвященный септическому острому повреждению почек (С-ОПП), синдрому, одновременно соответствующему критериям сепсиса и ОПП. Согласно статистике, у 30–50 % критических пациентов диагностируется или сепсис, или ОПП, при этом сепсис стимулирует развитие ОПП, а развитие ОПП — сепсис. Морбидность и летальность при С-ОПП выше, чем при сепсисе и ОПП по отдельности. Основные патофизиологические механизмы: а) развития ОПП при сепсисе: поступающая в почки «токсичная септическая» кровь содержит большое количество провоспалительных факторов, что повреждает канальцы и приводит к тубулярной дисфункции; б) развития сепсиса при ОПП: ОПП повреждает дистальные органы, а уремия — функции иммунной системы, что провоцирует развитие сепсиса. Для ранней диагностики и мониторинга С-ОПП должны проводиться параллельное измерение и мониторинг маркеров сепсиса и ренальной дисфункции. Однако, как показывают многочисленные данные, наличие ОПП приводит к неинфекционному повышению маркеров сепсиса, а наличие сепсиса повышает маркеры ОПП независимо от ренальной дисфункции. В целом при сепсисе ОПП и С-ОПП ренальные маркеры одновременно отражают как тяжесть ренальной дисфункции, так и тяжесть воспаления, а маркеры сепсиса — как тяжесть сепсиса, так и тяжесть ренальной дисфункции. Для определения пограничных уровней септических маркеров, применяемых для диагностики С-ОПП, необходимы рекомендации по повышению их значений в зависимости от степени тяжести ренальной дисфункции у критических пациентов.
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Рецензия
Для цитирования:
Вельков В.В. Сепсис и острое повреждение почек — дорога с двухсторонним движением: значения биомаркеров. Часть II. Медицинский алфавит. 2019;3(22):48-55. https://doi.org/10.33667/2078-5631-2019-3-22(397)-48-55
For citation:
Velkov V.V. Sepsis and acute kidney injury as two-way street: values of biomarkers. Medical alphabet. 2019;3(22):48-55. (In Russ.) https://doi.org/10.33667/2078-5631-2019-3-22(397)-48-55
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