Лимфопения как фактор, определяющий тяжесть сепсиса, как точный критерий диагностики и как объект терапии

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.

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