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Pădure, I. Dubinina, A. Ribin, O. Cuznetova, M. Zicov, E. Bachman, I. Gladun, I. Burebista, 93, bir. Marius Tiparul a fost executat la Tipografia Reclama sub Comanda nr. Chişinău, str. Alexandru cel Bun cum să ne ardem grăsimea corporală Ivanov D. Key words: SIRS systemic inflammatory response syndromehypoergic, hyperergic variants of neonatal sepsis.

A survey of 94 infants of the first week of life was made.

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The group of comparison was comprised by 23 newborns with acute pneumonia. On the bases of obtained data patterns of 2 lab-clinical variants of the SIRS were suggested.

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Pattern SIRS in hypoergic variant of sepsis is a deficient condition with prevalence of proteases in the spectrum of mediators against hypothyroidism of septic genesis.

Pattern SIRS in hyperergic variant of sepsis is a cytokine storm with maintained hormonal provision of protein-synthetic processes and immunity. Systemic inflammatory response syndrome- sirs is the pathogenetic basis of sepsis [1]. The neonatal SIRS developd in particular immunological status of newborn, birth stress and more often in premature i.

Years of research in the field of neonatal sepsis led us to the conclusion that there are at least 2 variants of sepsis. Initially by complex survey of children on 27 hemostatic parameters we were able to identify objective criteria to differentiate two patterns of DIC - decompensated and overcompensate for neonatal sepsis [2].

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Comparison of these data with the full range of clinical and laboratory data made it possible to formulate the concept of 2 clinical-laboratory variants of neonatal sepsis, hypoergic and hyperergic []. The aim of this study was to formulate a pattern of 2 clinical-laboratory variants of SIRS in neonatal sepsis on the basis of acute phase proteins spectrum, immunological parameters, hormonal profile, indixes of cellular reactivity.

This fact would help to create lx avansat fat burner 3 4 appropriate patterns of blood in combination with the previously formulated pattern of Lx avansat fat burner syndrome.

We examined 71 newborns with sepsis occurred vbg pierdere în greutate the first week of life in the dynamics of pathological process from 2 to 14 times.

A comparison group was comprised lx avansat fat burner infants with neonatal pneumonia - 23 children. Normative data for all hemostatic parameters were obtained and published lx avansat fat burner [6]. Research methods included the determination of platelet hemostasis: platelet count and assessment of their functional activity, studied by two methods: microscopic and using aggregometer. Platelet counts were determined by two methods: phase-contrast microscopy and in some cases with an automatic counter.

All parameters of coagulation hemostasis were determined using reagents of Behring company Germany. C and high molecular kininogen CMC were determined by enzymatic method. Determination of factor XIII was assessed by stability of the clot in the monochloroacetic acid. The content of degradation products of fibrin and fibrinogen FDP were examined by semiquantitative agglutination of staphylococci. Determination of immunoglobulin in the serum was performed by radial immunodiffusion Mancini G.

Circulating immune complexes CIC were determined by two methods: by precipitation in polyethylene glycol PEGand in some children by method of Kositskaya AS, et al. Determination of hormone levels somatotropingrowth hormone GHthyrotropin- thyroid-stimulating hormone TSHtriiodothyronine T3 in blood plasma were made using reagents of Hema company Moscowon the basis of technology from Fitzgerald International Industries, Inc.

The work of device is based on the low-frequency conductometry and does not require the introduction of substances into the blood, reducing research to 15 minutes. The measurement of osmolarity was carried out on osmometer OMKA 1C, on measuring the temperature of bioliquid freezing. Absolute and relative content of all white blood cell forms was assessed by the standard method. Since it was not designed to analyze septic condition and there was no promyelocyte in the formula, we have modified this formula including promyelocytes with coefficient 5.

In total were made: studies of the functional activity of platelets; definitions of the parameters of coagulation hemostasis and proteins of acute phase ; determinations of CIC and the three classes of immunoglobulin, determinations of the functional activity of macrophages NBT-test ; of certain hormones; 4 5 definitions of CBV and the osmolarity of blood plasma;calculated indices of cell reactivity; The results of all above mentioned studies were matched with the whole spectrum of clinical and routine laboratory data, including life history and diseases of parents, condition of the mother during pregnancy and childbirth, clinical and laboratory dynamics of the present condition in newborn.

In hyperergic variant «B» S. Contents of 12 th acute phase proteins, including members of the coagulation cascade and anticoagulants during the height period are shown in the Table 1.

Variant «A» had hypocoagulation with significantly lower levels of the above proteins, throm- bocytopenia with low aggregation activity.

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Variant «B» in spite of the current active DIC had high levels of these proteins lx avansat fat burner tendency to a reduce but higher level of platelets than variant «A». However, the values of α1-at 2. This correlates with a higher and more prolonged hypotension up to 2 weeks in variant «A» which required constant inotropic support. Systolic blood pressure in the form «A» was in average 35±4 mm Hg and in variant "B" and the hypotension period was short days.

Blood levels of circulating immune complexes CIC - left column and the phagocytic activity of leucocytes test with nitro blue tetrazolium NBT stimulated and basal respectively central and the right column in healthy newborns 1in patients with neonatal pneumonia 2with hyperergic variant B 3 and hypoergic variant A 4 of neonatal sepsis.

STG 2. Vatiant lx lx avansat fat burner fat burner - hypoergic and variant «B» - hyperergic.

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If variant «A» hypoergic at the height stage there was lower IgM, CIC as well as indicators of NBT - test both stimulated and basal production of levels of reactive oxygen species. The difference between stimulated and basal activity characterizes the low «reserve» of functional activity. This is consistent with lymphopenia observed for a long time up to 1 monthshift of leukocyte formula to the promyelocytes in the absence of metamyelocytes and myelocytes, presence of toxic granulation of neutrophils in the absence of neutrophilia, often full absence of eosinophils.

At the same time, the IgA levels were higher and correlated with the concentration of α1-at and vwf. In hyperergic variant CIC, IgM levels and functional activity of phagocytes NBT-test were initially higher and increased over time in a times correlating with increased levels of monocytes, lympho- cytes, eosinophils, LI and IIR index.

In group «B» such newborns accounted for only 7. Hormonal profile in the height stage of the process in hypoergic and hyperergic variants of neonatal sepsis were significantly different. None of the patients with hyperergic variant had low content of T3. So in hypoergic variant of sepsis in the majority of children took place as a dysfunction of the pituitary-thyroid system at birth and hypothyroidism of septic origin in the height of SIRS.

Reduced secretion of TSH may be related with the effect of dopamine due to prolonged inotropic support. Children with hyperergic variant of SIRS were characterized by more maturity of the axis hypothalamus - pituitary - thyroid lx avansat fat burner.

It was noted in According to our data, high content of growth hormone in the early stages of sepsis and its progressive reduction over time and the increase in T3 level are favorable signs. Poor outcome was associated with low levels of all the abovementioned hormones.

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Blood analysis and leukocyte indexes of reactivity are presented in Tables 2 and 3. Two variants of neonatal sepsis were significantly different for quantitative and qualitative composition of leukocytes at the beginning of the process. Initially, in variant «A» total number of leukocytes was an average of 7. In variant B the number of leukocytes at baseline was At the beginning of the process children in both groups were characterized by high LII and low LI and IIR, reflecting lower immune reactivity in which developed sepsis.

Myelocytes and metamyelocytes were absent in the blood ie, there was a «failure» resembling acute myeloid leukemia.


Simultaneously there was observed toxic granularity in neutrophils. This character of NSI was observed for a long time up to 38 days of life or death. We decided it was a sign of depletion of bone marrow pool reserve of neutrophils. A similar shift was observed in the form of a single episode in In hypoergic variant NSI is not regenerative.

The maximum absolute value of the monocytes content was 3.

The absolute content of lymphocytes significantly varied between episodes of lymphopenia to lymphocytosis minimum values were 1. The most informative criterion characterizing the different variants of SIRS was a combination of cell reactivity indices each of which reflects only a part of the process. High levels of LII correlate with the severity of endotoxemia but in different variants of SIRS it seems to reflect a different qualitative characteristic of the inflammatory mediator spectrum.

Increasing of indixes LI and IIR in favorable dynamics of clinical status is a good sign and indicates the increase in the relative content of lymphocytes. However, LI reflects only the proportion of their content in relation to the neutrophils.

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IIR reflects imbalance of basic cells that produce cytokines and imbalance in the cytokine profile in the presence of lymphopenia. Deficit of eosinophils means a lack of inflammation antimediator s hence the lack of detoxification component in the spectrum of mediators. Each index individually and one-time assessment does not allow differentiating the variant of SIRS and predicting of trend.

Revista de Cercetări Arheologice și Numismatice, Nr. VI, 2020

NSI in «A» variant usually masks low bone marrow reserve. Clinical-laboratory variants of SIRS in neonatal sepsis are not identified either in Russian or foreign literature. However, there were attempts to detect differences in the spectrum of cytokines IL1b, IL6, IL8, CSF colony-stimulating factors for grampositive and gram-negative sepsis, but their results were contradictory []. There is a common opinion about the imbalance of inflammation mediators, including cytokines in sepsis [10, ].

In our opinion, the contradictory of literature data indicates the existence of heterogeneity of SIRS and the presence of variants associated with both the features of the original reactivity and the type of pathogen. Our data on the initial low concentrations of TSH and T3, low content of total protein, IgG in hypoergic variant «A» indicate the immaturity of the system hypothalamus - pituitary - thyroid gland at birth and suggest the lx avansat fat burner mechanisms of immunological protection and hormonal support.

The predominance of gram-negative bacteria as the causative agents of sepsis in the group «A» requires a higher level of endotoxemia. ET leading to a reduction of lx avansat fat burner pool of leukocytes, exposure of vascular endothelium triggers the activation of proteolytic cascade systems of the kp astrologie pentru pierderea în greutate [15].

Obviously in variant «A» there is no appropriate level of antimediators in particular due to lack of eosinophils and low protein synthetic capacity of the organism. Lx avansat fat burner hypoergic variant «A» we revealed more pronounced violation of ability of phagocytes to a full answer in the NBT-test due to neutropenia.

We associate this fact with higher levels of ET able to activate neutrophils with elastase releasing [19], damage cells and stimulate apoptosis of neutrophils [] and low T3 level []. Hypothyroidism of septic origin, noted by us only in hypoergic variant, consistent with the idea of ET damaging effect especially for TSH receptor on thyroid follicular cells. Damage of the entire hypothalamicpituitary - thyroid axis in patients who died indicated Leon Sans et al [22,25,26].

In general, this variant of SIRS can be described as «deficient». It is necessary to keep in mind not only the shortage of protein, energy deficit and deficit of lymphokines due to lymphopenia and the possible shortage of cytokines of monocytic origin.

There are reports on the limitation lx avansat fat burner monocytes response of preterm children to ET «endotoxin tolerance» [27], decreased IL8 production in sepsis [28].

Thus, endotoxicosis in hypoergic sepsis A has a distinguishing quality characteristic from variant B. This is evidenced not only by differences in the spectrum of acute phase proteins, but also analysis of the complex indixes of cell reactivity we used.

Children with hyperergic variant did not have marked signs of thyroid function depression either at baseline or during the septic process. Lx avansat fat burner the causative agents gram-positive flora dominated so we could expect a stimulating influence of the staphylococcal enterotoxin as superantigen on the proliferation of lymphocytes and their contribution to the corresponding hypercytokinemia and toxemia.

However, we believe that in this variant of SIRS ET of gram-negative bacteria is involved which is received through the intestinal mucosa. Increased intestinal permeability in sepsis, serious injury, shock is regarded as a trigger of multiple organ failure [8].

ET, depending on the concentration may have different effects on the axis hypothalamus - pituitary - adrenal and pituitary glands - the thyroid gland [].

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In the same group distinguishing feature of the hormonal profile was the high basal level of growth hormone. The body s resistance of septic patient to endogenous and exogenous growth factor is associated with two factors: 1 reduction of the receptor expression for the growth hormone in the liver cells under the influence of cytokines and as a result reduction of the production of insulin-like growth factor - IFR1; 2 the presence of common signaling way of the growth hormone and IL-1β in the liver cells which prevents the realization of anabolic effects of GH [32, 33].

High levels of acute phase proteins not only in comparison with the variant A but higher than the norm in variant B and total plasma protein, we associate with the conservation of energy and plastic resources in this variant of sepsis and their hormonal support. We attribute this as with the peculiarities of the reactivity and with the type of pathogen contributing to a different cytokine profile.

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However, despite this fact there is no balance in the cytokine network in accordance with clinical data. We tend to agree with the characteristic of this SIRS as a «cytokine storm» [34].

References 1.

Lawrence K. Pediatric sepsis and multiorgan dysfunction syndrome: progress and continued challenges. Features hemostasis in newborn after severe perina- 8 9 tal pathologist. VA Almazova. Neonatal sepsis. Journal of them. GN Speranskii. The experience of hypotheses.