Almanac of Clinical MedicineAlmanac of Clinical MedicineАльманах клинической медицины2072-05052587-9294Moscow Regional Research and Clinical Institute (MONIKI)29610.18786/2072-0505-2014-30-91-98LECTUREЛЕКЦИЯMODERN CONCEPTS OF SEPSIS PATHOGENESIS AND PERSPECTIVE APPROACH TO IT''S TREATMENTСОВРЕМЕННАЯ КОНЦЕПЦИЯ ПАТОГЕНЕЗА СЕПСИСА И ПЕРСПЕКТИВНЫЕ ПОДХОДЫ К ЕГО ТЕРАПИИ (ЛЕКЦИЯ)ZulkarnaevA. B.ЗулькарнаевА. Б.
Russian Federation
VatazinA. V.ВатазинА. В.
Russian Federation
PasovS. A.ПасовС. А.
Russian Federation
PodojnicinA. A.ПодойницынА. А.
Russian Federation
The State Budgetary Healthcare Institution of Moscow Area Moscows regional research clinical institute n.a. M.F. VladimirskiyМосковский областной научно-исследовательский клинический институт им. М.Ф. Владимирского150120143091980203201602032016Copyright ©; 2014, Zulkarnaev A.B., Vatazin A.V., Pasov S.A., Podojnicin A.A.Copyright ©; 2014, Зулькарнаев А.Б., Ватазин А.В., Пасов С.А., Подойницын А.А.2014Zulkarnaev A.B., Vatazin A.V., Pasov S.A., Podojnicin A.A.Зулькарнаев А.Б., Ватазин А.В., Пасов С.А., Подойницын А.А.https://creativecommons.org/licenses/by/4.0https://almclinmed.ru/jour/article/view/296

Over the past hundred years, understanding of the sepsis pathogenesis as well as approaches to its treatment has dramatically changed. Great importance is attached to circulating inflammatory mediators. The paper presents the modern concept of the sepsis pathogenesis, some types of extracorporeal therapy and describes the main hypotheses to explain the effectiveness or ineffectiveness of the therapy.

В статье представлена современная концепция патогенеза сепсиса, а также некоторые виды экстракорпоральной терапии. Описаны основные гипотезы, объясняющие эффективность или неэффективность проводимой терапии.

sepsismultiple organ failurepathogenesiscytokinesextracorporeal haemocorrectionhemofiltrationsorptionсепсисполиорганная недостаточностьпатогенезцитокиныэкстракорпоральная гемокоррекциягемофильтрациясорбция1. Савельев B.C. Сепсис: классификация, клинико-диагностическая концепция и лечение: Практическое руководство/под ред. B.C. Савельева, Б.Р. Гельфанда. М.: ООО Медицинское информационное агентство, 2010. 2-е изд. 352 с.2. Яковлев М.Ю. Кишечный липополисахарид: системная эндотоксинемия -эндотоксиновая агрессия -SIR-синдром и полиорганная недостаточность как звенья одной цепи//Бюлл. ВНЦ РАМН. 2005. №1. С.15-18.3. Яковлев М.Ю. Кишечный эндотоксин -SIRS -полиорганная недостаточность//Труды РОП. 2006. Т.1. С.437-440.4. Abraham Е., Laterre P.F., Garbino J. et al. p55 tumor necrosis factor receptor fusion protein in severe sepsis and early septic shock: a randomized, doubleblind, placebo-controlled, multicenter phase III trial with 1,342 patients//Crit. Care Med. 2001. V.29. P.503-510.5. Angus D.C. Drotrecogin alpha (activated)..a sad final fizzle to a roller-coaster party//Crit. Care. 2012. V.16, No.l. P.107.6. Angus D.C., Birmingham M.C., Balk R.A. et al. E5 murine monoclonal antiendotoxin antibody in gram-negative sepsis: a randomized controlled trial. E5 Study Investigators//JAMA. 2000. V.283, No.13. P.1723-1730.7. Bellomo R., Tetta C., Ronco C. Coupled plasma filtration adsorption//Intens. Care Med. 2003. V.29, No.8. P.1222-1228.8. Berlot G., Bianco N., Tomasini A. et al. Changes in microvascular blood flow during coupled plasma filtration and adsorption//Anaesth. Intens. Care. 2011. V.39, No.4. P.687-689.9. Bone R.C., Grodzin C.J., Balk R.A. Sepsis: a new hypothesis for pathogenesis of the disease process//Chest. 1997. V.l, No.12. P.235-243.10. Cavaillon J.M., Adib-Conquy M., Cloëz-Tayarani I., Fitting C. Immunodepression in sepsis and SIRS assessed by ex vivo cytokine production is not a generalized phenomenon: a review//J. Endot. Res. 2001. V.7, No.2. P.85-93.11. Chong D.L., Sriskandan S. Pro-inflammatory mechanisms in sepsis//Contrib. Microbiol. 2011. No.17. P.86-107.12. Cinel I., Dellinger R.P. Advances in pathogenesis and management of sepsis//Cur. Opin. Infect. Dis. 2007. V.4, No.20. P.345-352.13. Formica M., Inguaggiato P., Bainotti S., Wratten M.L. Coupled plasma filtration adsorption//Contrib. Nephrol. 2007. No.156. P.405-410.14. Formica M., Olivieri С., Livigni S. et al. Hemodynamic response to coupled plasma filtration-adsorption in human septic shock//Intens. Care Med. 2003. V.29, No.5. P.703-708.15. Honoré P.M., Joannes-Boyau O., Collin V. et al. Continuous hémofiltration in 2009: what is new for clinicians regarding pathophysiology, preferred technique and recommended dose?//Blood Purif. 2009. V.28, No.2. P.135-143.16. López A., Lorente J.A., Steingrub J. et al. Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock//Crit. Care Med. 2004. V.32, No.l. P.21-30.17. Mao H.J., Yu S., Yu X.B. et al. Effects of coupled plasma filtration adsorption on immune function of patients with multiple organ dysfunction syndrome//Int. J. Artif. Organs. 2009. V.32, No.l. P.31-38.18. Nakamura M., Oda S., Sadahiro T. et al. Treatment of severe sepsis and septic shock by CHDF using a PMMA membrane hemofilter as a cytokine modulator//Contrib. Nephrol. 2010. No.166. P.73-82.19. Opal S., Laterre P.F., Abraham E. et al. Controlled Mortality Trial of Platelet-Activating Factor Acetyl hydrolase in Severe Sepsis Investigations. Recombinant human platelet-activating factor acetyl hydrolase for treatment of severe sepsis: results of a phase III, multicenter, randomized, double-blind, placebo-controlled, clinical trial//Crit. Care Med. 2004. V.32, No.2. P.332-341.20. Opal S.M., Fisher Jr. C.J., Dhainaut J.F. et al. Confirmatory interleukin-1 receptor antagonist trial in severe sepsis: a phase III, randomized, double-blind, placebo-controlled, multicenter trial//Crit. Care Med. 1997. V.25, No.7. P.1115-1124.21. Opal S.M., Laterre P.F., Francois B. et al. Effect of eritoran, an antagonist of MD2-TLR4, on mortality in patients with severe sepsis: the ACCESS randomized trial//JAMA. 2013. V.309, No.ll. P.1154-1162.22. Osuchowski M.F. Circulating cytokine/inhibitor profiles reshape the understanding of the SIRS/CARS continuum in sepsis and predict mortality//J. Immunol. 2006. V.177, No.3. P.1967-1974.23. Payen D., Mateo J., Cavaillon J.M. et al. Impact of continuous veno-venous hémofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial//Crit. Care Med. 2009. V.37, No.3. P.803-810.24. Peng Z., Pai P., Hong-Bao L. et al. The impacts of continuous veno-venous hémofiltration on plasma cytokines and monocyte human leukocyte antigen-DR expression in septic patients//Cytokine. 2010. V.50, No.2. P.186-191.25. Peng Z., Singbartl K., Simon P. et al. Blood purification in sepsis: a new paradigm//Contrib. Nephrol. 2010. No.165. P.322-328.26. Reade M.C., Huang D.T., Bell D. et al. Variability in management of early severe sepsis//Emerg. Med. J. 2010. V.7, No.2. P.110-115.27. Ronco C., Tetta С., Mariano F. et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis//Artif. Organs. 2003. V.27, No.9. P.792-801.28. Shubin N.J., Monaghan S.F., Ayala A. Antiinflammatory mechanisms of sepsis//Contrib. Microbiol. 2011. No.17. P.108-124.29. Stengl M., Sykora R., Chvojka J. et al. Differential effects of hémofiltration and of coupled plasma filtration adsorption on cardiac repolarization in pigs with hyperdynamic septic shock//Shock. 2010. V.33, No.l. P.101-105.30. Sykora R., Chvojka J., Krouzecky A. et al. Coupled plasma filtration adsorption in experimental peritonitis-induced septic shock//Shock. 2009. V.31, No.5. P.473-480.31. Taniguchi T. Cytokine adsorbing columns//Contrib. Nephrol. 2010. No.166. P.134-141.32. Thomas G., Jaber B.L. Convective therapies for removal of middle molecular weight uremic toxins in end-stage renal disease: a review of the evidence//Semin. Dial. 2009. V.22, No.6. P.610-614.33. Wiersinga W.J. Current insights in sepsis: from pathogenesis to new treatment targets//Cur. Opin. Crit. Care. 2011. V.17, No.5. P.480-486.34. Wunderink R.G., Laterre P.F., Francois B. et al. Recombinant tissue factor pathway inhibitor in severe community-acquired pneumonia: a randomized trial//Am. J. Respir. Crit. Care Med. 2011. V.183, No.11. P.1561-1568.35. Zhang J.M. Cytokines, inflammation, and pain//Int. Anesthesiol. Clin. 2007. V.45, No.2. P.27-37.