Klinički značaj nivoa rastvorljivog Fas u plazmi kod bolesnika sa sepsom
Sažetak
Uvod/Cilj. Cilj savremenih kliničkih i eksperimentalnih istraživanja u oblasti sepse je da se pronađe jedan ili više osetljivih parametara koji bi mogli da predvide težinu sepse i njen ishod. Cilj ovog rada bio je ispitivanje i upoređivanje odnosa početnih nivoa rastvorljivog Fas (sFas) u plazmi, kao i Acute Physiology, Age and Chronic Health Evaluation (APACHE) II skora sa težinom i ishodom sepse kod 58 bolesnika sa sepsom. Metode. Na osnovu kliničkih i laboratorijskih parametara istog dana postavljana je dijagnoza i vršena je procena težine bolesti. Iz uzoraka krvi određivani su standardni laboratorijski parametari potrebni za postavljanje dijagnoze sepse, disfunkcije organa i procenu težine bolesti, a, takođe, izmeren je i nivo sFas u plazmi. Prema konsenzus kriterijumima, bolesnici su podeljeni u grupe sa sepsom (n = 16), teškom sepsom (n = 30) ili septičkim šokom (n = 12), grupe sa (n = 26) i bez (n = 32) sindroma multiorganske disfunkcije (multiple organ dysfunction syndrome – MODS), i na preživele (n = 45) i bolesnike sa smrtnim ishodom (n = 13). Rezultati. Povišene nivoe sFas u plazmi (9,7 ± 10,1; 0–44.2 U/mL) imalo je 54,4% bolesnika, i to svi bolesnici sa septičkim šokom, 76,9% bolesnika sa MODS i 84,6% bolesnika sa smrtnim ishodom. Utvrđena je značajna pozitivna korelacija nivoa sFas u plazmi i APACHE II skora (p < 0,001). Bolesnici sa septičkim šokom imali su značajno više prosečne nivoe sFas u odnosu na normotenzivne bolesnike (p < 0.001). Značajno viši nivoi sFas utvrđeni su kod bolesnika sa MODS nego kod bolesnika bez MODS (p < 0.001 ), a značajno niži kod preživelih nego kod bolesnika sa smrtnim ishodom (p < 0.01). Zaključak. Početni nivoi sFas u plazmi kod bolesnika sa sepsom pozitivno korelišu sa vrednostima APACHE II skora i međusobno se razlikuju između bolesnika sa septičkim šokom i normotenzivnih bolesnika, bolesnika sa i bez MODS, kao i između preživelih i bolesnika sa smrtnim ishodom.
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