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Persona, Paolo (2010) Indagine sieroproteomica in pazienti con sepsi grave e shock settico. [Tesi di dottorato]

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Abstract (inglese)

The aim of this study was to evaluate the proteomic pattern of patients affected by sepsis, severe sepsis and septic shock. First of all we analyzed the common circulating factors to identify the best parameters to estimate severity, prognosis or further course of the disease. The best marker to estimate severity was procalcitonine (PCT). Higher values in severe sepsis and septic shock (p-value<0.012-0.001-0.001 and 0.003 on day 1-3-6 and 9) than in sepsis. D-dimers more increased in more critical patients too. About the relationship between parameters and outcome, there are significant differences in PCT-levels on day 9 (p<0.026, 2,05 µg/L in dead patients vs 0,4 µg/L in recovered patients). An important thrombocytopenia was observed on day 6-9 and 12 in patients with poor-outcome (p<0.02-0.02 and 0.012 respectively. On the proteomic side, we found significative expression of Platelet activating Factor 4, Cytokine A18 precursor, Apolipoprotein family and complement factors; only Complement factor 3 was related to severity of illness.

Abstract (italiano)

Obiettivo di questo studio è identificare, attraverso l’analisi sieroproteomica, eventuali nuovi marcatori in pazienti affetti da sepsi, sepsi grave e shock settico; mettere in luce differenze nel pattern proteomico tra pazienti che sopravvivono o meno alla sepsi; cercare nel pattern proteomico eventuali cause di fallimento della terapia standard del paziente settico.
Per fare ciò è stato necessario prima analizzare i pazienti secondo le caratteristiche cliniche e bioumorali, classificarli e identificare i migliori markers prognostici e indici di gravità. Si è proceduto poi ad analizzare i pattern sieroproteomici, cercando una relazione tra i dati clinici e bioumorali. L'indagine ha riguardato 61 pazienti affetti da sepsi, sepsi grave e shock settico. I dati bioumorali hanno rivelato una forte correlazione tra aumento di Procalcitonina e gravità del paziente, con buona correlazione con il SOFA score (Pearson's correlation 0,477; p=0,0001); Procalcitonina si è rivelata anche il miglior indice prognostico con p<0.026 in 6°giornata. Alterazioni della coagulazione con diminuzione di piastrine, aumento di D-dimero e variazione del PT hanno mostrato correlazioni significative con gravità e outcome non costanti però durante il periodo di osservazione. L'analisi sieroproteomica dei dati ha evidenziato nei pazienti settici una significativa alterazione nei confronti dei soggetti controllo di Platelet Activating Factor 4, Cytokine A18 precursor, di una serie di proteine della famiglia delle Apolipoproteine e di fattori del Complemento; solo Complement factor 3 è risultato essere correlato significativamente anche con la gravità del quadro clinico.

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Tipo di EPrint:Tesi di dottorato
Relatore:Gaion, Rosa Maria
Correlatore:Ori, Carlo
Dottorato (corsi e scuole):Ciclo 21 > Corsi per il 21simo ciclo > FARMACOLOGIA, TOSSICOLOGIA E TERAPIA
Data di deposito della tesi:NON SPECIFICATO
Anno di Pubblicazione:28 Gennaio 2010
Parole chiave (italiano / inglese):sieroproteomica sepsi shock settico marker
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/41 Anestesiologia
Struttura di riferimento:Dipartimenti > Dipartimento di Farmacologia ed Anestesiologia "E. Meneghetti"
Codice ID:2708
Depositato il:21 Set 2010 11:00
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