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2020, vol. 25, br. 77, str. 19-27
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Serumski biomarkeri sepse
Serum biomarkers of sepsis
aKlinički centar Srbije, Urgentni centar, Klinika za urgentnu hirurgiju , Beograd
bKlinički centar Srbije, Centar za anesteziologiju i reanimatologiju, Beograd
Sažetak
Sepsa je imunološki odgovor na sistemsku infekciju i širom sveta predstavlja sve veći problem u pogledu hospitalnog morbiditeta i mortaliteta. Brzi molekularni testovi, razvijeni da odgovore na potrebu brze i adekvatne dijagnostike, nisu uvek kadri da pruže jednoznačan odgovor. Izazovi sa kojim se suočavaju istraživači relevantnih biomarkera sepse leže u nedostatku jedinstvenog protokola i metodologije i nivoa dokaza. Pod sepsom se podrazumeva ceo skup poremećaja funkcije vitalnih organa i organskih sistema, koji dovode do multiorganske disfunkcije, otkazivanja funkcije osovine vitalnih organa i na kraju do smrti. Jedan od osnovnih problema u sepsi predstavlja činjenica da vrlo često nedostaju tipične i rane kliničke manifestacije. Za sada, ipak, zlatni standard dijagnoze sepse predstavlja tradicionalna upotreba mikrobnih kultura krvi (hemokultura). Glavno ograničenje upotrebne vrednosti kulture krvi je u dužini vremena potrebnom za detekciju uzročnika sepse. Biomarkeri bakterijske sepse: C-reaktivni protein je opšti protein reaktanta akutne faze Prokalcitonin je prekursor hormona kalcitonina i moćan je biomarker za bakterijske infekcije, serumski amiloid A (SAA) je važan apolipoprotein. Biomarkeri za infekcije izazvane gljivicama: Antitela mannan i anatimannan koriste se za otkrivanje gljivičnih infekcija zbog prisustva manna u ćelijskim zidovima invazivnih gljivičnih patogena. Glavni nedostatak dijagnostike upotrebom samo Mannan i Antimannan antitela je visoka stopa lažno pozitivnih i negativnih rezultata. Biomarkeri za virusne infekcije: interferon Gamma inducible protein 10 (IP-10) proinflamatorni hemokin je važan biomarker za dijagnostiku virusnih infekcija. Drugi biomarkeri (na raspolaganju ili u istraživanju): IL-10, proteinski vezani lipopolisaharid, rastvorljivi pokretački receptor (Soluble triggering receptor), tool-like receptors (TLRs), TLR-2 i neutrofilni CD64 receptori, CD163, mikro RNA (miRNA), SNP polimorfizam sa jednim nukleotidom, TNF alfa, IL-1 kinaza. Dobar biomarker može da ima ključni značaj u dijagnostici i diferencijalnoj dijagnostici i ishodu sepse.
Abstract
Sepsis is an innate immunological response of the systemic inflammatory pathway to infection, and is growing problem worldwide inn terms of mortality rates. Rapid molecular based tests have been developed to address this need but are not always accurate in this respect. The most commonly used biomarkers specially the serum markers are reviewed for their current uses and the diagnostic accuracies. Challenges that are faced during biomarker research lied in the lack of uniform protocol and methodology. define sepsis to be a systemic inflammatory response to a bacteria, virus or fungi. In clinical setting several other physiological symptoms must be presented to properly diagnose sepsis. The gold standard of sepsis diagnosis has been traditionally the use of microbial cultures to identify the source of illness. The major limitation of using cultures in the length of the time required to develop cultures to identifiable quantities to detect sepsis. The gold standard of sepsis diagnosis has been traditionally the use of microbial cultures to identify the source of illness. The major limitation of using cultures in the length of the time required to develop cultures to identifiable quantities to detect sepsis. Biomarkers for the Infections caused by Bacteria: C-reactive protein is the general acute phase reactant protein, Procalcitonin is a precursor of the hormone calcitonin and is another potent biomarker for bacterial infections, Serum Amyloid A is an important apolipoprotein, Biomarkers for the Infections caused by Fungi. Mannan and Antimannan antibodies are used to detect the fungal infections due to the presence of mannan in the cell walls of the invasive fungal pathogens. The main disadvantage Mannan and Antimannan antibodies test alone is the high rate of false positives and negatives. Biomarkers for Viral Infections: Interferon Gamma inducible protein 10 (IP-10) IP-10 a proinflammatory chemokine is an important biomarker for diagnosing viral infections. Other Biomarkers on Avenue: IL10, Lipopolysaccharide Binding Protein, Soluble triggering receptor, TLRs, Toll like Receptors 2 (TLR-2) and Neutrophil CD64 receptors, CD163, Micro RNAs, SNP, TNF Alpha, IL-1. Sepsis, as an increasing cause of mortality in the group of multiple injured and critically ill patients in the ICU, requires rapid diagnosis and treatment, and hence the importance of biomarkers is highly important.
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