Abstract
Dependence of prevalence and severity of bacteremia on the rate of liver impairment, serum bactericidal activity (SBA), and serum concentrations of C-reactive protein (CRP) and granulocyte colony-stimulating factor (G-CSF) in 80 hospitalized patients with liver cirrhosis (LC) have been studied. It was shown that risk factors associated with the development of bacteremia are high by Child-Pugh score and low SBA, CRP and G-CSF levels. Patients with LC, class A had the highest SBA, CRP and G-CSF levels. Still 14,3% of them developed less severe bacteremia associated with one type of microorganisms isolated from blood. Patients with LC, class B had intermediate SBA, CRP and G-CSF levels. They developed severe bacteremia in 52,6% of cases and less severe bacteremia – in 21,1% of cases. Patients with LC, class C had low SBA, CRP and G-CSF levels. They developed severe bacteremia in 62,5% of cases and less severe bacteremia – in 25% of cases.
Highlights
Ɂɧɮɟɤɰɢɢ ɫɥɭɠɚɬ ɩɪɢɱɢɧɨɣ ɫɦɟɪɬɢ 30-50% ɛɨɥɶɧɵɯ ɰɢɪɪɨɡɨɦ ɩɟɱɟɧɢ. ɉɨɫɥɟ ɝɨɫɩɢɬɚɥɢɡɚɰɢɢ ɧɨɡɨɤɨɦɢɚɥɶɧɵɟ ɢɧɮɟɤɰɢɢ ɪɚɡɜɢɜɚɸɬɫɹ ɭ 15-35% ɢɡ ɧɢɯ [13]. ɋɱɢɬɚɟɬɫɹ, ɱɬɨ ɤɭɦɭɥɹɬɢɜɧɚɹ ɫɦɟɪɬɧɨɫɬɶ, ɫɨɩɭɬɫɬɜɭɸɳɚɹ ɥɸɛɨɣ ɢɧɮɟɤɰɢɢ ɩɪɢ ɰɢɪɪɨɡɟ, ɫɨɫɬɚɜɥɹɟɬ 43,5%. ɉɨɹɜɥɟɧɢɟ ɨɫɥɨɠɧɟɧɢɣ, ɜɵɡɜɚɧɧɵɯ ɛɚɤɬɟɪɢɹɦɢ, ɨɰɟɧɢɜɚɸɬ ɤɚɤ ɩɟɪɟɯɨɞ ɐɉ ɜ ɫɥɟɞɭɸɳɭɸ, ɤɪɢɬɢɱɟɫɤɭɸ ɫɬɚɞɢɸ ɡɚɛɨɥɟɜɚɧɢɹ [10]
Ⱦɥɹ ɥɟɱɟɧɢɹ ɢ ɩɪɨɮɢɥɚɤɬɢɤɢ ɢɧɮɟɤɰɢɣ ɩɪɢ ɰɢɪɪɨɡɟ ɢɫɩɨɥɶɡɭɸɬ ɚɧɬɢɛɢɨɬɢɤɢ, ɧɨ ɢɯ ɩɪɢɦɟɧɟɧɢɟ ɧɟ ɜɫɟɝɞɚ ɞɚɟɬ ɠɟɥɚɟɦɵɣ ɪɟɡɭɥɶɬɚɬ. ɍ ɛɨɥɶɧɵɯ ɫ ɧɨɡɨɤɨɦɢɚɥɶɧɵɦ ɋȻɉ, ɧɚɩɪɢɦɟɪ, ɬɟɪɚɩɢɹ ɚɧɬɢɛɢɨɬɢɤɚɦɢ ɧɟ ɩɪɢɧɨɫɢɬ ɷɮɮɟɤɬɚ ɜ 2641% ɫɥɭɱɚɟɜ [8]. ɗɬɨ ɫɜɹɡɚɧɨ ɫ ɲɢɪɨɤɢɦ ɪɚɫɩɪɨɫɬɪɚɧɟɧɢɟɦ ɭɫɬɨɣɱɢɜɵɯ ɜɨɡɛɭɞɢɬɟɥɟɣ, ɬɚɤɢɯ ɤɚɤ ɷɧɬɟɪɨɛɚɤɬɟɪɢɢ, ɩɪɨɞɭɰɢɪɭɸɳɢɟ ɛɟɬɚɥɚɤɬɚɦɚɡɵ ɪɚɫɲɢɪɟɧɧɨɝɨ ɫɩɟɤɬɪɚ, ɢ
Ƚɪɚɦɩɨɡɢɬɢɜɧɵɟ ɤɨɤɤɢ ɜɵɞɟɥɹɥɢɫɶ ɢɡ ɤɪɨɜɢ 37,5%, ɚ ɫɬɚɮɢɥɨɤɨɤɤɢ – 10,7% ɛɨɥɶɧɵɯ. ȼ ɬɪɢ ɪɚɡɚ ɱɚɳɟ ɜɵɫɟɜɚɥɢɫɶ ɝɪɚɦɩɨɡɢɬɢɜɧɵɟ (25%) ɢ ɝɪɚɦɧɟɝɚɬɢɜɧɵɟ (10,7%) ɩɚɥɨɱɤɨɜɢɞɧɵɟ ɛɚɤɬɟɪɢɢ. ȼ ɤɪɨɜɢ 16,1 % ɛɨɥɶɧɵɯ ɛɵɥɢ ɨɛɧɚɪɭɠɟɧɵ ɝɪɢɛɵ ɪɨɞɚ Candida, ɭ 8,9% ɢ 1,8% ɩɚɰɢɟɧɬɨɜ ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ - ɚɤɬɢɧɨɦɢɰɟɬɵ ɢ ɝɪɚɦɧɟɝɚɬɢɜɧɵɟ ɤɨɤɤɢ
Summary
Ʉɨɥɢɱɟɫɬɜɨ ɜɢɞɨɜ ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ, ɜɵɹɜɥɹɟɦɵɯ ɜ ɤɪɨɜɢ ɑɢɫɥɨ ɛɨɥɶɧɵɯ (%), ɩɪɢɧɚɞɥɟɠɚɳɢɯ ɤ ɪɚɡɧɵɦ ɤɥɚɫɫɚɦ ɐɉ ɩɨ ɑɚɣɥɞ-ɉɶɸ ɤɥɚɫɫ Ⱥ ɤɥɚɫɫ ȼ ɤɥɚɫɫ ɋ. Ⱦɨɥɢ ɛɨɥɶɧɵɯ ɫ ɐɉ ɤɥɚɫɫɚ Ⱥ ɜ ɝɪɭɩɩɚɯ II ɢ III ɛɵɥɢ ɦɟɧɶɲɟ ɜ 7,8 (ɪ=0,010) ɢ 5,3 ɪɚɡɚ (ɪ=0,017) ɫɨɨɬɜɟɬɫɬɜɟɧɧɨ. Ȼɨɥɟɟ 40% ɛɨɥɶɧɵɯ ɫ ɐɉ ɤɥɚɫɫɚ ȼ ɫɨɫɬɚɜɥɹɥɢ ɝɪɭɩɩɭ ɩɚɰɢɟɧɬɨɜ II ɫ ɛɚɤɬɟɪɢɟɦɢɟɣ ɜ ɜɚɪɢɚɧɬɟ ɦɨɧɨɮɥɨɪɵ. Ȼ ɝɪɭɩɩɟ III ɢɯ ɛɵɥɨ ɜ 1,6 ɪɚɡɚ ɦɟɧɶɲɟ (ɪ=0,002). Ȼɨɥɶɲɢɧɫɬɜɨ ɛɨɥɶɧɵɯ ɫ ɞɟɤɨɦɩɟɧɫɢɪɨɜɚɧɧɵɦ ɐɉ ɤɥɚɫɫɚ ɋ ɫɨɫɬɚɜɥɹɥɢ ɝɪɭɩɩɭ III ɫ ɛɚɤɬɟɪɢɟɦɢɟɣ ɜ ɜɚɪɢɚɧɬɟ ɩɨɥɢɮɥɨɪɵ. Ȼ ɤɚɠɞɨɣ ɢɡ ɢɡɭɱɟɧɧɵɯ ɝɪɭɩɩ ɛɨɥɶɲɢɧɫɬɜɨ ɫɨɫɬɚɜɥɹɥɢ ɩɚɰɢɟɧɬɵ ɫ ɐɉ ɤɥɚɫɫɚ ȼ, ɱɬɨ ɭɤɚɡɵɜɚɥɨ ɧɚ ɧɟɩɨɥɧɨɟ ɫɨɜɩɚɞɟɧɢɟ ɪɟɡɭɥɶɬɚɬɨɜ ɨɰɟɧɨɤ ɩɨɪɚɠɟɧɢɹ ɩɟɱɟɧɢ ɢ ɩɪɨɬɢɜɨɦɢɤɪɨɛɧɨɣ ɭɫɬɨɣɱɢɜɨɫɬɢ ɩɚɰɢɟɧɬɨɜ, ɨɩɪɟɞɟɥɹɜɲɟɣɫɹ ɩɨ ɧɚɥɢɱɢɸ ɛɚɤɬɟɪɢɟɦɢɢ. Ʉɚɤ ɩɨɤɚɡɚɧɨ ɧɚ ɪɢɫɭɧɤɟ 2, ɡɧɚɱɟɧɢɹ ȻȺɋ ɩɨɫɥɟɞɨɜɚɬɟɥɶɧɨ ɫɧɢɠɚɥɢɫɶ ɩɨ ɦɟɪɟ ɩɨɹɜɥɟɧɢɹ ɭ ɩɚɰɢɟɧɬɨɜ ɛɚɤɬɟɪɢɟɦɢɢ ɢ ɭɜɟɥɢɱɟɧɢɹ ɱɢɫɥɚ ɦɢɤɪɨɨɪɝɚɧɢɡɦɨɜ, ɜɵɞɟɥɹɜɲɢɯɫɹ ɢɡ ɤɪɨɜɢ. Ɏɚɪɚɤɬɟɪɧɵɟ ɢɡɦɟɧɟɧɢɹ ȻȺɋ ɭ ɛɨɥɶɧɵɯ ɫ ɪɚɡɧɵɦ ɤɨɥɢɱɟɫɬɜɨɦ ɜɢɞɨɜ ɦɢɤɪɨɛɨɜ ɜ ɤɪɨɜɢ ɫɜɢɞɟɬɟɥɶɫɬɜɭɸɬ, ɩɨ ɧɚɲɟɦɭ ɦɧɟɧɢɸ, ɨ ɬɨɦ, ɱɬɨ ɭ ɛɨɥɶɧɵɯ ɢɡ II ɢ III ɝɪɭɩɩ ɛɚɤɬɟɪɢɟɦɢɹ ɞɟɣɫɬɜɢɬɟɥɶɧɨ ɢɦɟɥɚ ɦɟɫɬɨ. Ɨɧɢ ɞɟɦɨɧɫɬɪɢɪɭɸɬ ɫɭɳɟɫɬɜɨɜɚɧɢɟ ɡɚɜɢɫɢɦɨɫɬɢ ɦɟɠɞɭ ɬɹɠɟɫɬɶɸ ɩɨɪɚɠɟɧɢɹ ɩɟɱɟɧɢ, ɭɪɨɜɧɹɦɢ ȻȺɋ ɢ ɤɨɥɢɱɟɫɬɜɟɧɧɵɦ ɢ ɤɚɱɟɫɬɜɟɧɧɵɦ ɫɨɫɬɚɜɨɦ ɦɢɤɪɨɛɧɵɯ ɫɨɨɛɳɟɫɬɜ ɜ ɤɪɨɜɢ. ɉɨɞɬɜɟɪɠɞɟɧɢɟ ɷɬɨɝɨ ɛɵɥɨ ɩɨɥɭɱɟɧɨ ɩɪɢ ɢɡɭɱɟɧɢɢ ɋɊȻ ɢ Ƚ-ɄɋɎ ɭ ɨɛɫɥɟɞɨɜɚɧɧɨɣ ɱɚɫɬɢ ɛɨɥɶɧɵɯ (ɪɢɫɭɧɨɤ 3). ȼ I ɢ II ɝɪɭɩɩɚɯ ɛɵɥɨ ɨɛɫɥɟɞɨɜɚɧɨ ɩɨ 9 ɛɨɥɶɧɵɯ, ɜ III ɝɪɭɩɩɟ -11 ɩɚɰɢɟɧɬɨɜ
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