Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2014 Vol. 22 No 4

GENERAL AND SPECIAL SURGERY

D.M. OVSIANIK

THE DIAGNOSIS OF INFECTED PANCREATIC NECROSIS BASED ON AN ASSESSMENT OF INDICATORS OF ENDOTHELIAL DYSFUNCTION

EE “Vitebsk State Medical University”,
The Republic of Belarus

Objectives. To study the indicators of endothelial dysfunction in acute pancreatitis and assess their potential for differential diagnosis of infected and sterile pancreatic necrosis.
Methods. A prospective investigation of indicators of endothelial dysfunction - the number of circulating endothelial cells and concentration of stable degradation products of nitric oxide in the blood of patients (n=92) with various forms of acute pancreatitis has been carried out. The results of a study of healthy volunteers (n=15) were used as a control. For diagnostic test evaluation of sensitivity/specificity for forecast verification and diagnosis of infected pancreatic necrosis the Receiver Operating Characteristic (ROC) analysis has been applied.
Results. In case of the edematous form of acute pancreatitis a statistically significant increase of circulating endothelial cells number and the level of nitrate/nitrite in the blood by 1.5-folds compared to healthy persons (ð=0,0051; ð=0,0206) have been observed. An expressive clinical manifestation of endothelial dysfunction has been occurred in pancreatic necrosis, as for its sterile course the tendency to regress have been appeared. In the infected pancreatic necrosis the negative dynamics demonstrating this disease usually was found in increase of the number of circulating endothelial cells in the blood. Within the first week of hospitalization the level of nitrate/nitrite – >36 uM/L (sensitivity – 81,8%, specificity – 60,3%, AUC=0,7; ð=0,0323) may be used in prediction of infected pancreatic necrosis. The presence of 39 and more circulating endothelial cells in 100 ul. plasma (sensitivity – 84 %, specificity – 86%, AUC = 0,834; p <0,001) happen to be one of diagnostic signs of infection of pancreatic necrosis in the second phase of disease.
Conclusions. The received results testify to expediency of the research of endothelial dysfunction by determination of the number of circulating endothelial cells in the blood of patients with acute pancreatitis as a method should be applied for early detection of infection of pancreatic necrosis.

Keywords: acute pancreatitis, infected pancreatic necrosis, endothelial dysfunction, diagnostics
p. 428 – 435 of the original issue
References
  1. Ermolov AS, Ivanov PA, Blagovestnov DA, Grishin AV, Andreev VG. Diagnostika i lechenie ostrogo pankreatita [Diagnosis and treatment of acute pancreatitis]. Mosñow, RF: Vidar. 2013. 384 p.
  2. Litvin AA. Infitsirovannyi pankreonekroz [Infected pancreatic necrosis]. Moscow, RF: Integratsiia; 2011. 240 p.
  3. Savel'ev VS, Filimonov MI, Gel'fand BR, Burnevich SZ. Infitsirovannyi pankreonekroz [Infected pancreatic necrosis]. Infektsii v Khirurgii. 2003;1(2):34–39.
  4. Forsmark CE. Pancreatitis and its complications. New Jersey: Humana Press Inc, 2005. 349 p.
  5. Petukhov VA. Endotelial'naia disfunktsiia: sovremennoe sostoianie voprosa (po materialam nauchnogo simpoziuma) [Endothelial dysfunction: current status of the issue (based on scientific symposium)]. Khirurgiia. Prilozhenie Consiliun medicum. 2008;(1):3–11.
  6. Sushkov SA, Nebylitsyn IuS, Samsonova IV, Miadelets OD, Kozlovskii VI. Strukturnye i funktsional'nye izmeneniia endoteliia pri eksperimental'nom venoznom tromboze [Structural and functional alterations of the endothelium in experimental venous thrombosis]. Kl³n³chna Flebolog³ia. 2013;6(1):126–35.
  7. Kolbasova EA, Kiseleva NI, Tikhonova LV. Issledovanie tsirkuliruiushchikh endotelial'nykh kletok u patsientok s khirurgicheskoi i estestvennoi menopauzoi [The study of circulating endothelial cells in patients with surgical and natural menopause]. Mat' i Ditia v Kuzbasse. 2013;(1):8–13.
  8. Savel'ev VS, Petukhov VA, An ES. Disfunktsiia endoteliia pri lipidnom distress-sindrome i dismetabolicheskikh posledstviiakh peritonita [Endothelial dysfunction in lipid distress syndrome and dismetabolic consequences of peritonitis]. Rus Med Zhurn. 2009;17(14):881–90.
  9. Semenova AS, Morrison VV, Dolishnii VN. Vozmozhnosti uluchsheniia rezul'tatov lecheniia patsientov s abdominal'nym sepsisom na osnove patogeneticheskikh printsipov [Opportunities to improve patient outcomes with abdominal sepsis based on pathogenetic principles]. Fundam Issledovaniia. 2008;(7):23–25.
  10. Savel'ev VS, Petukhov VA. Peritonit i endotoksinovaia agressiia [Peritonitis and endotoxin aggression]. Moscow, RF: 2012. 326 p.
  11. Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis. Atlanta. September 11-13, 1992. 1993;128(5):586–90.
  12. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Acute Pancreatitis Classification Working Group. Gut. 2013 Jan;62(1):102–11.
  13. Hladovec J. Circulating endothelial cells as a sign of vessel wall lesions. Physiol Bohemoslov. 1978;27(2):140–44.
  14. Zan'ko SN, Kiseleva NI, Solodkov AP, Khotetovskaia ZhV. Opredelenie kolichestva tsirkuliruiushchikh endotelial'nykh kletok v plazme krovi: instruktsiia po primeneniiu [Determination of the number of circulating endothelial cells in blood plasma]. Viteb gos med un-t. ¹ 91-1004; utv. 21.06.2005. Sovrem metody diagnostiki, lecheniia i profilaktiki zabolevanii]. Minsk, RB; 2005;2(6):63–65.
  15. Veremei IS, Osochuk SS, Shcherbinin IIu, Deiun GV, Dubrovskaia AV, Solodkov AP. Fotometricheskii metod opredeleniia nitratov i nitritov v biologicheskikh zhidkostiakh [Photometric method for the determination of nitrate and nitrite in biological fluids] : instruktsiia po primeneniiu.Viteb gos med un-t. ¹ 91-0008; utv. 19.03.2001. Sovrem. metody diagnostiki, lecheniia i profilaktiki zabolevanii. Minsk, RB; 2003;2(3):5–12.
  16. Grinkhal'kh T. Osnovy dokazatel'noi meditsiny [Basics of evidence-based medicine]. Moscow, RF: GEOTAR-Media, 2006. 240 p.
Address for correspondence:
210023, Respublika Belarus, g. Vitebsk, pr. Frunze, d. 27, UO «Vitebskiy gosudarstvennyiy meditsinskiy universitet», kafedra fakultetskoy khirurgii,
e-mail: ovsyanik.dmitriy@yandex.ru,
Ovsianik Dmitriy Mechislavovich
Information about the authors:
Ovsianik D.M. A post-graduate student of the faculty surgery chair of EE “Vitebsk State Medical University”.
Contacts | ©Vitebsk State Medical University, 2007-2023