Синдром надпочечниковой недостаточности у пациентов кардиологического и кардиохирургического профиля в критическом состоянии

Комлев А.Е., Курилина Э.В., Имаев Т.Э. Синдром надпочечниковой недостаточности у пациентов кардиологического и кардиохирургического профиля в критическом состоянии. Терапевтический архив. 2019; 91 (10): 100–105. DOI: 10.26442/00403660.2019.10.000313

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Komlev A.E., Kurilina E.V., Imaev T.E. Critical illness-related corticosteroid insufficiency in patients after cardiac surgery and cardiologic emergencies. Therapeutic Archive. 2019; 91 (10): 100–105. DOI: 10.26442/00403660.2019.10.000313

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Аннотация

Надпочечниковая недостаточность у пациентов в критическом состоянии (ННКС) ассоциируется с повышенным уровнем циркулирующих биомаркеров системного воспаления, прокоагулянтными изменениями гемостаза, ухудшением течения системного воспалительного ответа и соответствующим удлинением сроков госпитализации и увеличением летальности у пациентов реанимационных отделений различного профиля. В зависимости от диагностических критериев и особенностей исследуемой популяции частота встречаемости ННКС, по разным данным, варьирует в широких пределах, достигая 30% у послеоперационных больных, нуждающихся в вазопрессорной поддержке. ННКС представляет собой сложный клинико-патологический феномен, который может оказывать существенное влияние на ближайший прогноз и выживаемость больных. Клиническое значение ННКС, равно как и вопросы патогенетической терапии этого состояния, привлекают активное внимание специалистов в области интенсивной терапии и клинической патологии. Специфические аспекты ННКС у пациентов кардиохирургического и кардиологического профиля недостаточно освещены в литературе, что обусловливает необходимость их дальнейшего изучения.

Ключевые слова: надпочечниковая недостаточность у пациентов в критическом состоянии, кардиохирургия, неотложная кардиология.

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Critical illness-related corticosteroid insufficiency (CIRCI) is associated with elevated level of circulating biomarkers of inflammation, pro-coagulant effects, deterioration of systemic inflammatory response syndrome (SIRS) and, consequently, prolonged in-hospital stay and increased mortality of intensive care patients. Incidence of CIRCI widely varies depending on specific patient’s population and applied diagnostic thresholds being as high as 30% among postoperative patients on inotropes. CIRCI is a complex clinical and pathophysiological condition with substantial influence on immediate survival and prognosis. Clinical impact of CIRCI as well as pathogenetically based therapy arouse keen interest of intensive care specialists and clinical pathologists. The specific issues of CIRCI in patients after cardiac surgery and cardiology emergencies remain largely under-recognized, so further scrutinization is needed.

Keywords: critical illness-related corticosteroid insufficiency, cardiac surgery, intensive cardiology.

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________________________________________________

1. Selye H. A syndrome produced by diverse nocuous agents. Nature. 1936;136:32. doi: 10.1038/138032a0
2. Carrasco GA, van de Kar LD. Neuroendocrine pharmacology of stress. Eur J Pharmacol. 2003;463:235-72. doi: 10.1016/S0014-2999(03)01285-8
3. Annane D, Pastores SM, Arlt W, et al. Critical Illness-Related Corticosteroid Insufficiency (CIRCI): A Narrative Review from a Multispecialty Task Force of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). Crit Care Med. 2017;45(12):2089-98. doi: 10.1007/s00134-017-4914-x
4. Dimopoulou I, Alevizopoulou P, Dafni U, et al. Pituitary-adrenal response to human corticotropin-releasing hormone in critically ill patients. Intensive Care Med. 2007;33:454-9. doi: 10.1097/01.CCM.0000108885.37811.CA
5. Arlt W, Stewart PM. Adrenal corticosteroid biosynthesis, metabolism, and action. Endocrinol Metab Clin North Am. 2005;34:293-313. doi: 10.1016/j.ecl.2005.01.002
6. Sakaue M, Hoffman BB. Glucocorticoids induce transcription and expression of the alpha 1B adrenergic receptor gene in DTT1 MF-2 smooth muscle cells. J Clin Invest. 1991;88:385-9. doi: 10.1172/JCI115315
7. Orlowski J, Lingrel JB. Thyroid and glucocorticoid hormones regulate the expression of multiple Na,K-ATPase genes in cultured neonatal rat cardiac myocytes. J Biol Chem. 1990;265:3462-70.
8. Elenkov IJ, Iezzoni DG, Daly A, et al. Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation. 2005;12:255-69. doi: 10.1159/000087104
9. Marik PE, Pastores SM, Annane D, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36(6):1937-49. doi: 10.1097/CCM.0b013e31817603ba
10. Rivers EP, Gaspari M, Saad GA, et al. Adrenal insufficiency in high-risk surgical ICU patients. Chest. 2001;119(3):889-96. doi: 10.1378/chest.119.3.889
11. Kilger E, Weis F, Briegel J, et al. Stress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery. Crit Care Med. 2003;31:1068-74. doi: 10.1097/01.CCM.0000059646.89546.98
12. Marik PE, Zaloga GP. Adrenal insufficiency in the critically ill: a new look at an old problem. Chest. 2002;122:1784-96. doi: 10.1378/chest.122.5.1784
13. Shenker Y, Skatrud JB. Adrenal insufficiency in critically ill patients. Am J Respir Crit Care Med. 2001;163:1520-3. doi: 10.1164/ajrccm.163.7.2012022
14. Knighton JD, Woodock TE, Hough M. Adrenal failure in the critically ill. Br J Anaesth. 1999;82(1):152-3. doi: 10.1093/bja/82.1.152
15. [Murray R, Granner D, Mayes P, Rodwell V. Human biochemistry. 21st ed. Norwalk – San Mateo: Appleton & Lange, 1988].
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20. [Gavrilova AE, Smirnov VV. Hypoglycemic syndrome: causes, diagnosis. Lechashchij Vrach. 2010;(11):34-43 (In Russ.)].
21. Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med. 2007;35(10):2262-7. doi: 10.1097/01.ccm.0000282073.98414.4b
22. Gibbison B, Lightman SL. Critical illness-related corticosteroid insufficiency in cardiogenic shock. Br J Anaesth. 2014 Apr;112(4):756-7. doi: 10.1093/bja/aeu065
23. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017 Mar;43(3):304-77. doi: 10.1007/s00134-017-4683-6
24. Algarni KD, Maganti M, Yau TM. Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: Trends over 20 years. Ann Thorac Surg. 2011;92:1678-84. doi: 10.1016/j.athoracsur.2011.06.017
25. You Jung O, Ju Yong L, Sung-Ho J. Critical Illness-Related Corticosteroid Insufficiency in Patients with Low Cardiac Output Syndrome after Cardiac Surgery. Korean J Thorac Cardiovasc Surg. 2018;51:109-13. doi: 10.5090/kjtcs.2018.51.2.109

Авторы

А.Е. Комлев, Э.В. Курилина, Т.Э. Имаев

ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия

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A.E. Komlev, E.V. Kurilina, T.E. Imaev

National Cardiology Research Center, Moscow, Russia

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