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Regulation of CⅡTA to Major Histocompatibility Complex Class Ⅱ Gene in Multiple Organ Dysfunction Syndrome

目的 探讨主要组织相容性复合体(MHC)Ⅱ类基因的反式转录因子（CⅡTA）在多器官功能障碍综合征（MODS）中对MHCⅡ类基因的调控机理。方法 18只雄性家猪随机分为实验组（n=9）和对照组(n=9)。实验组给予失血性休克、再灌注损伤、内毒素血症等复合干扰因素，建立二次打击猪MODS模型； 对照组仅进行麻醉和动静脉插管。7 d后处死存活动物。切取实验组造模成功动物和对照组动物的脾脏组织，用Trizol法提取总RNA。设计CⅡTA和猪MHCⅡ类基因(SLA-DQA)引物序列，逆转录构建cDNA，行实时荧光定量PCR检测。UVP计算机图像分析系统绘出标准曲线并得出2组CⅡTA mRNA和SLA-DQA mRNA的拷贝数。以Pearson法分析MODS动物CⅡTA mRNA和SLA-DQA mRNA表达的相关性。结果 实验组动物死亡7例，有8例发生MODS。对照组动物CⅡTA mRNA的拷贝数为（3.516±1.237）×103，实验组MODS动物为（0.367±0.088）×103，差异有统计学意义（P=0.000）； 对照组SLA-DQA mRNA拷贝数为（5.330±3.053）×103，实验组为（1.376±1.006）×103，差异亦有统计学意义(P=0.002)。MODS动物中CⅡTA mRNA和SLA-DQA mRNA的表达呈正相关(Pearson值为0.499，P=0.017)。结论 MODS模型复制满意。MHCⅡ类基因在MODS中表达下降与CⅡTA的调控有关。

Clinical Study of Chaiqin Chengqi Decoction in Treating Severe Acute Pancreatitis Accompanied with Multiple Organ Dysfunction Syndrome in Early Stage

目的:探讨早期应用柴芩承气汤治疗重症急性胰腺炎(severe acute pancreatitis,SAP)伴多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的临床疗效。方法:88例符合病例选择标准并接受柴芩承气汤治疗的SAP伴MODS住院患者,按院外病程长短分为早期组(48 h内入院接受治疗,44例)和晚期组(48～72 h内入院接受治疗,44例),比较治疗过程中两组患者器官功能障碍持续时间、住院时间、感染率、中转手术率及病死率。结果:早期组急性呼吸窘迫综合征、肾功能衰竭、心功能衰竭、肝功能不全、脑病、凝血系统损害的持续时间低于晚期组(Plt;0.05);早期组住院时间、感染率、中转ICU率、中转手术率及病死率低于晚期组(Plt;0.05)。结论:早期应用柴芩承气汤治疗SAP伴MODS能减少器官损害持续时间,减轻器官损害,从而缩短病程,减少后期感染率及中转手术率,降低病死率。

The Clinical Research on the Concurrent Severe Acute Pancreatitis and Multiple Organ Dysfunction and Its Prognosis

目的　探讨重症急性胰腺炎并发多器官功能障碍及预后关系的临床研究。 方法　回顾分析2008年1月－2010年12月收治的51例重症急性胰腺炎患者的临床资料。 结果　其中出现全身炎症反应综合征者46例（90.20%），多器官功能障碍36例（70.59%），重症急性胰腺炎并发多器官功能障碍者治愈好转20例，未合并者治愈好转13例。死亡18例。 结论　引起重症急性胰腺炎患者死亡的最主要因素是多器官功能障碍，早预防、早发现、综合治疗多器官功能障碍有助于降低重症急性胰腺炎患者死亡率。

导管相关性血流感染致乳腺癌术后化疗患者多器官功能障碍救治体会

随着重症医学的发展, 中心静脉导管被广泛应用于重症患者的血流动力学监测、快速扩容、长期输液、血液净化及全胃肠外静脉营养等, 但留置中心静脉导管可致导管相关性感染, 如出口部位感染、隧道感染、皮下囊感染和导管相关性血流感染( CRBSI) [ 1] 。本院曾诊治过1 例先天性左肾缺如的乳腺癌术后化疗后因CRBSI 致多器官功能障碍综合征( MODS) 患者, 病情复杂、救治难度大, 现报告如下。......

THE EFFECT OF GASTROINTESTINAL TRACT ISCHEMIA ON THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME

Objective To make clear the effect of gastrointestinal tract ischemia on multiple organ dysfunction syndrome (MODS). Methods The literature in the recent years was reviewed.Results The low-flow states of gastrointestinal tract and decrease of gastrointestinal intramucosal pH, which occured following a variety of insults (sever trauma, hemorrhagic shock, et al), as well as overgrowth of enterobacteria, may result in a significant increase of permeability of bowel and lead to endotoxemia and bacterial translocation. Ischemia also resulted in release of TNF, IL-6 into the systemic circulation, dysfunction of gastrointestinal tract motility, and activation of neutrophile which was integral in local and distant organ damage. Conclusion These data suggest that the management of correct ischemia of gastrointestinal tract, which include fluid infusion to replacement of blood volume, early enteral nutrition, improvement of gastrointestinal movement, could contribute to improve the intestinal barrier function, and prevent the development of MODS.

Comparison of APACHEⅡ and Ⅲ Scoring System in Predicting the Prognosis of Patients with Acute Kidney Injury and Multiple Organ Dysfunction Syndrome in ICU

Objective To compare the clinical value of Acute Physiology and Chronic Health Evaluation ( APACHE) Ⅱ / Ⅲ scoring system in predicting the prognosis of patients complicated with acute kidney injury ( AKI) and multiple organ dysfunction syndrome ( MODS) in ICU. Methods 318 patients with AKI and MODS treated with continuous blood purification in ICU fromJanuary 2004 to June 2010, were evaluated with APACHE Ⅱ and APACHEⅢ and analyzed retrospectively. The area under the receiveroperating characteristic curve ( AUC) and the Lemeshow-Hosmer goodness-of-fit of APACHEⅡ and Ⅲ were assessed. Results Mean scores and predicted hospital mortality of APACHEⅡ and Ⅲ were all significantly lower in the survival group than those in the non-survival group ( P lt; 0. 01) . The AUC were 0. 782 for APACHEⅡ, and 0. 755 for APACHEⅢ, with Youden’s indexes of 46. 4% and 36. 7% , respectively. Hosmer-Lemeshow test showed the calibration of the two systems was reasonable. Conclusion APACHEⅡ and Ⅲ are both good for predicting the severity and prognosis of patients complicated with AKI and MODS in ICU but APACHEⅡ is superior in clinical practice.

Protective Strategies for Organ Function of Fulminant Acute Pancreatitis in Early Stage

ObjectiveTo explore protective strategies for organ function of fulminant acute pancreatitis (FAP) in early stage. MethodsThe clinical data of 37 patients with FAP admitted to this hospital within 72 h after onset of symptoms between January 2000 and September 2010 were analyzed retrospectively. FAP was defined as presence of multiple organ dysfunction syndrome (MODS) within 72 h after onset of symptoms. A total of 37 patients with a confirmed diagnosis of FAP were divided into two groups based on whether adopting the protective strategies for organ function in early stage or not. Patients treated between January 2000 and May 2004 did not adopt the protective strategies for organ function (Named nonprotection group, n=21); The other patients treated between June 2004 and September 2010 adopted protective strategies for organ function (Named protection group, n=16). With the exception of the protecting strategies for organ function, the patients with severe acute pancreatitisin received standard treatment in two groups. The acute physiology and chronic health evaluation (APACHE) Ⅱ score and multiple organ dysfunction score (Marshall), rate of pancreas infection, and case fatality were compared between two groups. ResultsCompared with the nonprotection group on day 3 after admission, APACHEⅡ score and Marshall score decreased in the protection group (APACHEⅡ score : 15.71±2.95 versus 17.72±3.77, P=0.137; Marshall score: 6.93±2.73 versus 8.06±2.36, P=0.206, respectively). In addition, the case fatality on day 7 and in hospital case fatality in the protection group decreased as compared with the nonprotection group (case fatality on day 7: 18.75% versus 33.33%, P=0.461; in hospital case fatality: 43.75% versus 57.14%, P=0.515, respectively). There was no significant difference of the rate of pancreas infection between two groups (P=1.000). ConclusionsIt from a case of a particular disease perspective, though the difference is not significant, but the observed improvement in prognosis is attributed by protective strategies for organ function of FAP in early stage to a certain degree, however it is verified by needing to more cases.

Clinical Study of 226 Cases of Severe or Very Severe Chronic Obstructive Pulmonary Disease Exacerbation Combining with Multiple Organ Dysfunction Syndrome

摘要:目的: 探讨重度、极重度COPD急性加重期合并多MODS临床特征和预后有关的危险因素。 方法 :回顾分析1999～2009年因重度、极重度COPD急性期合并多器官功能障碍而住院的患者临床资料。 结果 :本研究共纳入226例患者,平均年龄为693±52岁。呼吸系统功能障碍发生率最高,有200例。其次是心血管功能障碍和中枢神经功能障碍,各102例。患者的病死率随着器官功能障碍的数目增加而增加。 结论 :治疗重度、极重度COPD急性加重时,在常规治疗基础的同时防治MODS是降低患者病死率的关键。Abstract: Objective: To analyze the clinical characters and risk factors that relevant to prognosis of severe or very severe chronic obstructive pulmonary disease(COPD)exacerbation combining with multiple organ dysfunction syndrome(MODS). Methods :The clinical data of patients who was admitted to hospital for exacerbation of severe or very severe COPD combing with MODS ｉｎ 1999 to 2009 were retrospective analyzed. Results : 226 cases were analyzed in this study, the mean age of patients was 693±52 The incidence of respiratory system dysfunction was highest, which was 200 cases, and followed by the incidence of cardiovascular dysfunction and central nervous system dysfunction, which was 102 respectively. The mortality of these patients increased with the increasing number of organ dysfunction. Conclusion : Pｒｅｖｅｎｔ ａｎｄ te at MODS on the basis of conventional treatment of severe or very severe COPD exacerbation is the key factor that could reduce mortality of these patients.

别嘌醇与多种非甾体抗炎药联用致多器官功能障碍一例

The Expression and Clinical Significance of Myoglobin, Creatine Kinase and Inflammatory Mediators in Serum of Patients with Multiple Trauma Patients

Objective To investigate the dynamic expression and clinical significance of myoglobin, creatine kinase and inflammatory mediators in the serum of patients with multiple trauma. Methods From May 2013 to March 2015, 56 patients with multiple trauma admitted in EICU were recruited in the study. According to the injury severity, 56 patients were divided into a mild trauma group, a medium trauma group and a severe trauma group. The subjects were further divided into a MODS group and a non-MODS group based on multiple organ dysfunction syndrome (MODS) criteria. Twenty healthy adults undergoing physical examination were recruited as control. Serum myoglobin, creatine kinase, IL-6 and TNF-α levels were measured in the multiple trauma patients (1st day, 3rd day, 7th day and 14th day) and the controls. Results Compared with the controls, the serum levels of myoglobin, creatine kinase, IL-6 and TNF-α in the patients with multiple trauma increased significantly from 1st to 14th day after injury (allP＜0.05). Serum myoglobin, creatine kinase, IL-6 and TNF-α levels on 3rd day after injury reached the peak, then decreased gradually in the mild, medium, and severe trauma groups, among which the changes of serum myoglobin, creatine kinase, IL-6 and TNF-α levels were significant on 3rd day compared with other timepoints (allP＜0.05). On 1st day after injury, serum levels ofmyoglobin, creatine kinase, IL-6 and TNF-α also differed significantly between the MODS group and non-MODS group (allP＜0.05). The AUCs of myoglobin, IL-6 and TNF-α for predicting MODS were 0.527-0.817, 0.641-0.890, and 0.197-0.544, respectively. Conclusions The dynamic changes of serum myoglobin, creatine kinase, IL-6 and TNF-α in patients with multiple trauma are correlated well with the injury severity and prognosis. Serum myoglobin, IL-6 and TNF-α levels may be good markers to predict secondary MODS in multiple trauma patients.