jsmsJournal of Siberian Medical SciencesJournal of Siberian Medical Sciences2542-1174Federal state budgetary educational institution of higher education "Novosibirsk state medical university" of Ministry of Health of the Russian Federation (FSBEI HE NSMU MOH Russia)10.31549/2542-1174-2020-3-108-125jsms-654Research ArticleОБЗОРЫREVIEWЛимфопения как фактор, определяющий тяжесть сепсиса, как точный критерий диагностики и как объект терапииLymphopenia as a determinant factor of sepsis severity, as an exact diagnostic criterion, and as an object of therapyСтрельцоваЕ. И.StreltsovaЕ. I.

Стрельцова Елена Ивановна — канд. мед. наук, доцент кафедры анестезиологии и реаниматологии; заведующий отделением реанимации и интенсивной терапии, заместитель главного врача по лечебной части

Новосибирск

ПешковаИ. В.PeshkovaI. V.

Пешкова Инесса Викторовна — д-р мед. наук, доцент кафедры анестезиологии и реаниматологии

Новосибирск

СаматовИ. Ю.SamatovI. Yu.

Саматов Игорь Юрьевич — ассистент кафедры анестезиологии и реаниматологии; заведующий отделением реанимации и интенсивной терапии ожогового центра, заместитель главного врача по анестезиологии, реаниматологии и интенсивной терапии

Новосибирск

ВалееваВ. А.ValeevaV. А.

Валеева Влада Арнольдовна — канд. мед. наук, доцент кафедры анестезиологии и реаниматологии

Новосибирск

ВерещагинЕ. И.VereshchaginЕ. I.

Верещагин Евгений Иванович — д-р мед. наук, профессор, заведующий кафедрой анестезиологии и реаниматологии

630091, г. Новосибирск, Красный просп., 52

Vereshchagin Evgeny Ivanovich — Dr. Sci. (Med.), Professor, Department of Anesthesiology and Resuscitation

52, Krasny Prospect, Novosibirsk, 630091

eivv1961@gmail.comФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава России; ГБУЗ НСО «Государственная Новосибирская областная клиническая больница»РоссияNovosibirsk State Medical University; Novosibirsk State Regional Clinical HospitalRussian FederationФГБОУ ВО «Новосибирский государственный медицинский университет» Минздрава РоссииРоссияNovosibirsk State Medical UniversityRussian Federation20200411202003108125Copyright © Стрельцова Е.И., Пешкова И.В., Саматов И.Ю., Валеева В.А., Верещагин Е.И., 20202020Стрельцова Е.И., Пешкова И.В., Саматов И.Ю., Валеева В.А., Верещагин Е.И.Streltsova Е.I., Peshkova I.V., Samatov I.Y., Valeeva V.А., Vereshchagin Е.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://jsms.elpub.ru/jour/article/view/654

Попытки оптимизации диагностики сепсиса и его осложнений привели к созданию концепции Сепсис-3, вступающей в противоречие с основными положениями терапии этого угрожающего состояния, а именно — максимально ранним началом лечения. В свою очередь, внедрение новых методов мониторинга и протезирования функций органов при полиорганной недостаточности не вызвало заметного улучшения результатов терапии сепсиса. Широкое распространение резистентных к антибиотикотерапии штаммов также требует поиска новых подходов в диагностике и терапии сепсиса. Настоящий обзор призван акцентировать внимание на таком типичном для сепсиса явлении, как абсолютная лимфопения. многочисленные исследования показывают, что именно лимфопения определяет тяжесть течения сепсиса. Композитные индексы (соотношение нейтрофилы/лимфоциты (neutrophil-lymphocyte count ratio, NLCR) или лимфоцитарный индекс (соотношение лимфоциты/гранулоциты периферической крови)) являются наиболее надежными критериями в диагностике сепсиса. Кроме того, представленные данные свидетельствуют о том, что коррекция лимфопении достоверно улучшает прогноз при сепсисе. Очевидно, что признание ключевой роли абсолютной лимфопении в патогенезе, диагностике и терапии сепсиса послужит толчком к дальнейшему развитию концепции сепсиса.

Attempts to optimize the diagnosis of sepsis and its complications have led to the development of Sepsis-3 concept which contradicts the basic provisions of therapy for this threatening condition, namely, the earliest possible onset of the treatment. In turn, the introduction of new methods for monitoring and substitution of organ functions in multiple organ failure did not cause a noticeable improvement in the results of sepsis therapy. The high incidence of antibiotic-resistant strains also requires the search of the new approaches in the diagnosis and therapy of sepsis. The present review is intended to focus on such a typical sepsis phenomenon as absolute lymphopenia. Numerous studies show that it is lymphopenia that determines the severity of sepsis. Composite biomarkers (the neutrophil-lymphocyte count ratio, NLCR) or lymphocyte index (the lymphocyte/peripheral blood granulocytes ratio)) are the most reliable criteria in sepsis diagnosis. In addition, the presented data suggest that lymphopenia correction significantly improves prognosis in sepsis. It seems clear that the acknowledgment of the absolute lymphopenia’s key role in pathogenesis, diagnosis and therapy of sepsis will serve as an impulse for further development of sepsis concept.

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The authors declare that there are no conflicts of interest present.