Summary. The goal of the robot is to determine the factors of decompensation of the systemic inflammatory response syndrome (SIRS) in abdominal sepsis (AS). Materials and methods. Based on the results of a comprehensive examination of 295 patients with AS according to the indicators of clinical and laboratory, biochemical, immunological examination and study of intra-abdominal pressure and the severity of enteral insufficiency, the leading factors in the development of DSIRS were determined. Results and discussion. It was found that against the background of secondary cellular immunodeficiency, the development of severe compartment syndrome with decompensated enteric insufficiency syndrome (EIS) was determined, which in combination deepened pathological changes with the progression of the inflammatory reaction and the development of organ failure. Indicators of the level of C-reactive protein 2.5 times, and procalcitonin 2.4 times were higher during hospitalization of patients with decompensated syndrome (P<0.001). With decompensation, a severe degree of SES was diagnosed 18.5 times more often, and with a compensated one, a mild degree of insufficiency was diagnosed 57 times more often, P <0.001. At the same time, a direct correlation was determined between the severe degree of EIS and symptoms of nausea (r = 0.420), vomiting (r = 0.573) and bloating (r = 0.251), (P <0.005). The immunoregulatory index (IRI) played the role of a marker of decompensation in patients with AS, (r = + 0.74, at p <0.01) with the development of secondary immunodeficiency, according to the T-suppressor type. In 60.8 % (n = 101) of cases with DSIRS, the fourth degree of intra-abdominal pressure was determined, on average it was (46.3 ± 6.3) mm, and I degree was determined only in the case of compensation, (P <0.001). More often in patients with DSIRS, the associations of gram-positive microorganisms and enterococci were determined — in 55.6 % and streptococci — in 38.1 % of cases. At the same time, in 81.3 % of cases, patients with DSIRS were diagnosed with aerobic-anaerobic mixed flora. Сonclusion. The obtained results of the study require the development of treatment methods that will effectively correct these pathogenetic changes in all directions in patients with AS.

Цель работы -обосновать возможность диагностики и прогнозирования асептических и инфицированных местных осложнений острого панкреатита путем определения уровня иммуноглобулинов класса G.Материалы и методы. Обследовали 30 пациентов с острым панкреатитом (отечная и некротическая формы). Группу контроля составили пациенты, госпитализированные для проведения планового оперативного вмешательства по поводу паховой грыжи, варикозной болезни и фиброаденомы молочной железы (n = 10). Лабораторные и иммунологические исследования проводили трижды: при поступлении, на 7 и на 14 сутки. Проведен иммуноферментный анализ субклассов IgG (G1, G2, G3, G4) в основной группе исследования.Результаты. Медиана выживаемости без осложнений среди всех обследованных составляет 12 дней (95 % ДИ 2,0-28,0). При дефиците иммуноглобулинов это время уменьшается и составляет при снижении уровня общего IgG 10 дней (95 % ДИ 10,0-71,0). При сравнении групп с пониженным уровнем иммуноглобулинов по сравнению с нормальными показателями такая тенденция прослеживается для всех субклассов, а статистически значимое различие между ними установлено по IgG4. Отмечено достоверное (p = 0,049) расхождение кривых Каплана-Мейера в сторону уменьшения выживаемости без осложнений у пациентов с низким уровнем IgG4 (медиана выживаемости -2,0 дня, 95 % ДИ 1,0-17,0) по сравнению с его нормальным и высоким уровнем (Ме = 28,0; 95 % ДИ 10,0-71,0).Запорожский медицинский журнал. Том 21, № 6(117), ноябрь -декабрь 2019 г. ISSN 2306-4145 http://zmj.zsmu.edu.ua V. I. Desiateryk, D. V. Maltsev, M. S. Krykun, V. V. Shapovaliuk, M. M. Shkura The aim. To substantiate the possibility of diagnosis and prediction of aseptic and infected local complications of acute pancreatitis (AP) by determining the level of immunoglobulins of class G.Materials and methods. 30 patients with AP (oedematous and necrotic form) were examined. The control group consisted of patients scheduled for inguinal hernia, varicose vein and breast fibroadenoma surgery (n = 10). Laboratory and immunological studies were carried out three times: the 1st study -upon admission; the 2nd -on the 7th day; the 3 -on the 14th day. An enzymelinked immunoglobulin analysis of IgG subclasses (G1, G2, G3, G4) was performed in the main study group.Results. Median survival time is 12 days (95 % CI 2.0-28.0) among all examined patients. This time decreases in immunoglobulins deficiency and is 10 days (95 % CI 10.0-71.0) in total IgG level decrease. When comparing groups with a lower level of immunoglobulins and normal, this trend is reflected in all subclasses, and a statistically significant difference between them is detected for IgG4. There is a significant difference (p = 0.049) in Kaplan-Mayer's curves in terms of reducing survival without complications in patients with low IgG4 level (median survival 2.0 days, 95 % CI 1.0-17.0) compared to normal and high its level (Me = 28.0; 95 % CI 10.0-7.0).Survival without complications of the examined patients increases statistically significantly with an increase in the total level of im...