ObjectiveTo explore the expression of programmed death-1 ligand (PD-L1) on peripheral blood monocytes in septic mice, and analyze the difference between the mild and severe septic mice. MethodsFirstly, thirty C57 mice were randomly divided into a sham group, a mild sepsis group and a severe sepsis group. Sepsis model was induced by cecal ligation and puncture (CLP). The severity of sepsis was distinguished by length of cecum ligated. Survival rate was recorded after CLP and compared between three groups. Then sixty C57 mice were randomly divided into a sham group, a mild sepsis group and a severe sepsis group. Peripheral blood was obtained at 6 h and 24 h to detect PD-L1 expression on monocytes in peripheral blood by flow cytometry. Tumor necrosis factor-α(TNF-α) and interleukin-10 (IL-10) in serum were detected by enzyme-linked immunosorbent assay. ResultsThe survival rate in the mild sepsis group was higher than that in the severe sepsis group. TNF-αand IL-10 levels in the mild and severe sepsis groups were higher than those in the sham group at 6 h and 24 h (P < 0.01). PD-L1 expression on monocytes in the mild and severe sepsis groups was higher than that in the sham group at 6 h and 24 h (P < 0.05). The expression of PD-L1 in the severe sepsis group was higher than that in the mild sepsis group, however, there was no statistical difference between two groups (P > 0.05). ConclusionsPD-L1 expression on monocytes is increased in septic mice. PD-L1 expression tended to increase in severe sepsis compared with the mild sepsis.
【Abstract】 Objective To study the effects of glutamine (Gln) combined with growth hormone （GH） on the levels of cytokine (TNF-α, IL-1, IL-6), coritsol and amino acid metabolism in septic rats. Methods Ten out of 79 SD rats were randomly collected as the control group. Thirty of 69 septic SD rats, which were made by cecal ligation and perforation (CLP) method and were given parenteral nutrition (PN) lived to day 6. They were also randomly divided into three groups as follows: septic group (n=10), parenteral supplemented glutamine group (Gln group, n=10), and Gln combined with GH (Gln+GH group, n=10). On the 6th day, blood drew from portal veins of the dead rats was used to detect the levels of TNF-α， IL-1， IL-6 and cortisol by ELISA. The plasma concentrations of free amino acids were determined by amino acid auto-analyzer. The muscle tissue of extensor digitorum longus was used to determine 3-methyl-histidine (3-MH) by high performance liquid chromatographic (HPLC). Results Except for the control group, most rats developed celiac abscess, hepatic abscess and pulmonary infection. The serum levels of TNF-α, IL-1, IL-6 and cortisol were significantly higher in the septic group than those of the other three groups, and they were significantly lower in the Gln+GH group than those of the Gln group, P＜0.05. Compared with the other three groups, the concentration of total amino acid in the septic group increased more, among which the glutamine and the branched chain amino acids were prominent. Most of concentrations of the amino acids decreased in the Gln group and the Gln+GH group, and the decreased amplitude of the Gln+GH group was larger, P＜0.05, albeit its level of Gln markedly increased. The concentration of 3-MH in muscle tissue was the highest in septic group, and it was significantly higher in the Gln group than that of the Gln+GH group, P＜0.01. ConclusionIt may be necessary to supplement GH combined with Gln as the content of PN to decrease cytokine levels and im-prove amino acid metabolism for septic case.
ObjectiveTo elucidate the metabolic characteristics of mitochondria in sepsis and review its cellular mechanism, so as to provide new ideas for the treatment of sepsis. MethodThe previous literatures and latest research results about mitochondrial metabolism during sepsis were reviewed. ResultsAt present, the researchers were not only concerned about the inflammatory response of sepsis, but also concerned about the systemic metabolic disorder caused by sepsis. It was believed that the damage of mitochondria caused by sepsis was one of the main reasons for the disorder of cell metabolism. During the sepsis, the patient’s metabolism had changed, for example, enhancement of aerobic glycolysis, lactic acid accumulation, elevated levels of fatty acids and triglycerides in blood, and so on. ConclusionMetabolic change during sepsis is related to mitochondria, which can provide some new methods for treatment of sepsis.
Sepsis is a common clinical critical illness, which often leads to multiple organ damage including the kidney damage, which is difficult to treat and has a high mortality rate. In recent years, extracorporeal blood purification therapy has made some progress in the field of sepsis. There are a variety of blood purification modes to choose, but there is still no unified standard for the initiation timing of blood purification therapy. Clinicians mainly evaluate the indicators and the initiation timing of blood purification therapy according to the patient’s needs for renal function replacement and/or inflammatory mediator clearance. This article mainly summarizes and discusses the initiation timing of blood purification therapy in sepsis.
Sepsis 已经成为危重症医学中较为常见的一种综合征，它定义为因病原体感染而引起的全身性炎症反应综合征。严重Sepsis患者预后不佳，治疗上也较为困难，特别是合并Septic Shock和多器官功能不全综合征（MODS）的患者，死亡率仍然较高，因此近年来在临床及研究上均已引起明显的重视。为了能促进Sepsis的研究及治疗，国际上多个医学专科分会联合发起“拯救Sepsis运动（Surviving Sepsis Campaign, SSC）”，并于2004年首次发表了相应的指南，即Surviving Sepsis Campaign Guideline for Management of Severe Sepsis and Septic Shock。今年初SSC再次发表了新版的指南，主要是结合近年的研究成果而在原版的基础上进行适当的补充和更新，以指导临床上严重Sepsis的抢救及治疗。
Objective To explore the clinical significance of the platelet glycoproteins CD62p and CD63 in septic patients.Methods The expressions of CD62p and CD63 in peripheral platelet were measured in 40 septic patients within 24 hours after onset by flow cytometry.The expression levels of CD62p and CD63 in mild and severe sepsis and normal subjects were compared.Meanwhile the correlation of CD62p and CD63 with APACHE Ⅱ score was analyzed.Results Significant differences in the CD62p and CD63 levels were found in the septic patients when compared with the normal subjects [CD62p：（2.56±1.51）% vs （1.48±0.40）%；CD63：（2.15±0.50）% vs （1.29±0.35）%；all Plt;0.01].The expressions of CD62p and CD63 in the severe septic patients were significantly higher than those in the mild septic patients [CD62p：（3.31±1.94）% vs （2.05±0.87）%；CD63：（2.37±0.36）% vs （2.00±0.53）%；all Plt;0.05].The positive correlations of CD62p and CD63 with APACHE Ⅱ score were also found（CD62p：r=0.377，P=0.016；CD63：r=0.452，P=0.003）.Conclusion Platelets were significantly activated in septic patients at early stage which was correlated with the severity of sepsis.
Objective To investigate the pathological characteristics of hepatic energy metabolism changes due to biliary sepsis. Methods The hepatic mitochondrial respiratory function and content of ATP was dynamically measured in the self controlled rabbit model of biliary sepsis.Results The mitochondrial S3, respiration control rate (RCR) and phosphorus/oxygen (P/O) were significantly dropping in the infective hepatic lobe 12 hrs after operation with S4 increasing markedly, and the oxidative phosphorylation was uncoupled from 48 hrs after operation onward. The hepatic mitochondrial RCR showed early ascending and then dropping in the non-infective hepatic lobe. The content of ATP and mitochondrial respiratory activity decreased synchronously in both hepatic lobes. Conclusion The hepatic energy metabolic failure was induced in the early stage by biliary sepsis. This is probably the pathological basis of biliary sepsis that is highly critical and always lead to MOF following acute liver function failure.
ObjectiveTo investigate the prognostic value of serum procalcitonin (PCT) level and its change for patients with severe trauma and sepsis. MethodsEighty-two patients with severe trauma and sepsis treated between June 2013 and June 2014 were chosen to be our study subjects. According to the clinical outcome at day 28, they were divided into survival group (n=54) and death group (n=28). Serum procalcitonin levels at hour 0, 24, 48, 72, 96, and 120 after admitted to the emergency intensive care unit were detected in all the patients. Then we calculated the rate of procalcitonin change in each time points, injury severity score (ISS) score, acute physiology and chronic health evaluation (APACHE)Ⅱ score and white blood cells (WBC) count. ResultsProcalciton level at hour 24, 48, 72, 96 and 120 of the survival group was significantly lower than the death group (P<0.05); the rate of procalcitonin change at hour 24, 48, 72, 96 and 120 was significantly lower than the death group (P<0.05), and the APACHE Ⅱ score was significantly lower than the death group (P<0.01). There was no significant difference in the ISS score and WBC count between the two groups (P>0.05). ConclusionEarly procalcitonin level and its dynamic change are good indicators in judging the prognosis of patients with severe trauma and sepsis, especially the early dynamic change in the rate of procalcitonin.