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Prognostički značaj proteina HMGB1 u difuznom sekundarnom peritonitisu

Prognostic value of protein HMGB1 in a diffuse secondary peritonitis

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2016
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Author
Milić, Ljiljana
Mentor
Peško, Predrag
Committee members
Grigorov, Ilijana
Karamarković, Aleksandar
Šijački, Ana
Bogojević, Desanka
Metadata
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Abstract
Sekundarni peritonitis je hirurško stanje koje iziskuje neodložno operativno lečenje. Često je praćen sepsom sa relativno visokom incidencom i stopom smrtnosti. Intraabdominalna infekcija kao izvor sepse aktivira zapaljenje tokom kog brojni medijatori određuju patogenetski tok i ishod sekundarnog peritonitisa. U ovoj doktorskoj disertaciji smo istraživali povezanost nivoa HMGB1 (engl. high mobility group box 1) proteina preoperativno i postoperativno do otpusta iz bolnice, kao i akutne markere inflamacije: serum amiloid A (SAA) i češće ispitivane markere, kao što su C-reaktivni protein (CRP) i prokalcitonin (PCT), sa razvojem sindroma sistemskog inflamatornog odgovora (SIRS) i sepse kod pacijenata sa sekundarnim peritonitisom. Uticaj operativnog lečenja na kinetiku ovih markera je poređen sa nivoima kod pacijenata sa preponskim kilama bez znakova inflamacije. Nađene su značajno više preoperativne vrednosti svih ispitivanih markera u grupi sa peritonitisom u odnosu na pacijente sa kilam...a. U grupi sa peritonitisom, preoperativne vrednosti i vremenski obrazac promene HMGB1 su se značajno visoko razlikovale u grupi pacijenata koji su razvili sepsu, u odnosu na grupu kod koje SIRS nije bio praćen infekcijom. Kod septičnih pacijenata, vrednosti HMGB1 su blago opadale prvih dana posle operacije, dosežući najnižu tačku trećeg dana praćenja. Potom su rasle do sedmog postoperativnog dana, da bi nakon toga vrednosti opadale. Sa druge strane, u grupi SIRS, najniže vrednosti se registruju već prvog postoperativnog dana praćenja, da bi potom postepeno porasle, sa maksimumom u trećem postoperativnom danu i oscilirale između te dve vrednosti do kraja perioda praćenja. Preoperativne vrednosti SAA se nisu razlikovale kod septičnih pacijenata i pacijenata sa SIRS-om, ali se obrazac promene SAA postoperativno značajno razlikovao među ovim grupama. Kod septičnih pacijenata su vrednosti vrlo značajno porasle nakon prvog postoperativnog dana, a zatim kontinuirano opadale do kraja perioda hospitalizacije. Nasuprot tome, kod pacijenata sa SIRS-om, vrednosti su opadale u odnosu na preoperativnu vrednost, što je bilo visoko značajno različito, u odnosu na grupu septičnih pacijenata. Preoperativne vrednosti CRP-a i PCT-a su bile značajno više u grupi septičnih pacijenata u odnosu na grupu sa SIRS-om. Vrednosti CRP-a dostižu maksimalne vrednosti drugog postopertivnog dana, a PCT-a prvog postoperativnog dana...

Secondary peritonitis is a surgical condition requiring immediate surgical treatment. It is often accompanied by sepsis with a relatively high incidence and mortality. Intraabdominal infection as a sepsis source triggers inflammation during which a number of pathogenic mediators determine the course and the outcome of the secondary peritonitis. In this doctoral thesis we investigated the correlation of the level of high mobility group box 1 protein (HMGB1), preoperatively and postoperatively until discharge from the hospital, as well as acute inflammatory markers: serum amyloid A (SAA), and more frequently assessed serological markers such as C-reactive protein (CRP) and procalcitonin (PCT), with the development of systemic inflammatory response syndrome (SIRS) and sepsis in patients with secondary peritonitis. The effect of operative treatment on the kinetics of these markers was compared with levels in patients with inguinal hernia without signs of inflammation. All investigated mark...ers had significantly higher preoperative values in the group with peritonitis compared to patients with hernias. Whitin the peritonitis group, preoperative values and the pattern changes of HMGB1 were highly significantly different in the group of patients who developed sepsis compared to the group in which SIRS was not accompanied by infection. In septic patients HMGB1 levels slightly declined in the first days after surgery, reaching the lowest point on the third day of the follow-up. Then they rose to seventh postoperative day, and after that value declined. On the other hand, in the group of SIRS lowest values are recorded on the first postoperative day of follow-up, but then gradually increased to a peak in the third postoperative day, oscillating between these two values until the end of the observation period. Preoperative SAA did not differ in septic patients and patients with SIRS, but the pattern of changes of SAA postoperatively was significantly different among these groups. In septic patients, SAA values increased significantly after the first postoperative day, and then continuously declined until the end of the period of hospitalization. By contrast, in patients with SIRS, values declined compared to the baseline, which was highly significantly different compared to the group of septic patients. Preoperative CRP and PCT were significantly higher in the group of septic patients compared to the group with SIRS. CRP value reached the maximum value of the second postopertive day and PCT on the first postoperative day...

Faculty:
Универзитет у Београду, Медицински факултет
Date:
31-08-2016
Keywords:
Sekundarni peritonitis / secondary peritonitis / HMGB1 / C-rekativni protein / prokalcitonin / serum amiloid A / markeri inflamacije / sepsa / SIRS / HMGB1 / C-reactive protein / procalcitonin / serum amyloid A / markers of inflammation / sepsis / SIRS
[ Google Scholar ]
Handle
https://hdl.handle.net/21.15107/rcub_nardus_6629
URI
http://eteze.bg.ac.rs/application/showtheses?thesesId=3961
https://nardus.mpn.gov.rs/handle/123456789/6629
https://fedorabg.bg.ac.rs/fedora/get/o:13291/bdef:Content/download
https://fedorabg.bg.ac.rs/fedora/get/o:13377/bdef:Izvestaj/download
http://vbs.rs/scripts/cobiss?command=DISPLAY&base=70036&RID=48251151

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