The role of the bacterial factor in the development of acute pancreatitis and its purulent-septic complicationsIntroduction. A feature of acute pancreatitis is the high risk of developing complications (occurring in 50% of patients), the total mortality of which reaches 15%, and in severe cases it varies within 40-70%.The aim of the study was to determine the role of Helicobacter pylori as an etiological factor of acute pancreatitis and a marker of the development of its purulent-septic complications.Materials and methods. The results of treatment of 280 patients with acute pancreatitis were analyzed, which were divided into two groups: the main group (n=187) -patients with severe acute pancreatitis and the comparison group (n=93) -patients with a mild and moderate course of the disease. In addition, in order to determine prognostic criteria for the development of purulent-septic complications, the patients of the main group were divided into two subgroups. The first subgroup included patients with a severe course and the development of purulentseptic complications (n=59), the second (n=128) -with a severe course without the development of purulent-septic complications of acute pancreatitis.Results. When screening patients for Helicobacter pylori, the results of the express test were positive in 232 patients (82.9%), while in the main group 165 (88.2%) patients, in the comparison group -75 (80.6%) patients (χ2= 2.9, 95% CI -1. 1-17.6, p=0.08). An increase in the content of immunoglobulin M to Helicobacter pylori was also determined in patients with a severe course of acute pancreatitis after 7 and 14 days from the moment of hospitalization, which indicates the acute phase of the disease. The correlation between immunoglobulin M and procalcitonin was strong (r=0.87; p=0.0001), but the relationship between these indicators was not linear, but closer to exponential (y=1.1543-2.7292*x +2.1604*x^2).Conclusions. The results of a screening study of Helicobacter pylori in patients with acute pancreatitis allow us to consider this microorganism as one of the factors in the pathogenesis of this disease (82.9% of cases). For patients with severe acute pancreatitis, the content of immunoglobulin M to Helicobacter pylori in blood serum ≥1.24 IU/ml can be considered as a likely predictor of the development of purulent-septic complications (sensitivity 86.4%, specificity 100.0%).

Введение. Острый панкреатит сопровождается высоким риском развития осложнений, летальность при которых может достигать 70%.Цель. Оценить эффективность парацентеза с дренированием брюшной полости в этапном лечении пациентов с осложненным течением острого панкреатита.Материалы и методы. Были проанализированы результаты лечения 60 пациентов с острым панкреатитом средней тяжести и тяжелым течением с наличием экссудата в брюшной полости. Пациенты были распределены на две группы (по 30 человек): в группе сравнения применяли стандартный этапный подход в лечении, в основной группе на первом этапе лечения дополнительно осуществляли парацентез с дренированием брюшной полости. Пациенты обеих групп достоверно не отличались по возрасту, полу, этиологии и тяжести течения заболевания. Эффективность лечения оценивали путем изучения лабораторных показателей крови в день обнаружения перитонеальной жидкости и через 72 часа. Дополнительно пациентам определяли внутрибрюшное давление. Также сравнивали частоту инфекционных осложнений в позднем периоде заболевания и продолжительность пребывания в стационаре.Результаты. Выявлена достоверная разница показателей внутрибрюшного давления у пациентов группы сравнения и основной группы через 72 часа с момента обнаружения жидкости (17,4±2,6 и 11,4±1,6 мм рт. ст., р<0,001), амилазы сыворотки крови (774,3±233,9 и 472,7±168,6 Ед/л, р<0,001), прокальцитонина (1,3±0,7 и 0,6±0,5 нг/мл, р<0,001) и интерлейкина-6 (531,3±120,9 и 417,1±82,4 пг/мл, р<0,001). В группе сравнения у 50% пациентов возникли инфекционные осложнения, а в основной группе – у 53,3% (р>0,05).Выводы. Раннее применение парацентеза с дренированием брюшной полости как первого этапа в лечении пациентов с острым панкреатитом с ферментативным перитонитом ведет к достоверному снижению уровня внутрибрюшного давления на 31%, прокальцитонина – на 32%, интерлейкина-6 – на 12%, амилазы – на 27% (р<0,001). Introduction. Acute pancreatitis is accompanied by a high risk of complications with about 70% mortality rate.Purpose. To evaluate the effectiveness of paracentesis of abdominal cavity in treatment of patients with complicated acute pancreatitis.Materials and methods. The treatment results of 60 patients with moderate and severe acute pancreatitis with the presence of exudate in the abdominal cavity were analyzed. The patients were divided into two groups (30 people each): a standard approach was used in treating the comparison group. Paracentesis of abdominal cavity was additionally performed at the first stage of treatment in the main group. There is no significant difference in patients of each group in age, sex, etiology and severity of the disease. The effectiveness of the treatment was assessed by studying laboratory blood parameters on the first day of detecting peritoneal fluid and after 72 hours. In addition, intra-abdominal pressure was determined for the patients. We also compared the incidence of infectious complications in the late phase of the disease and the length of hospital stay.Results. A significant difference in intra-abdominal pressure and other indicators wererevealed in patients in comparison group and the main group after 72 hours from the moment of detecting the liquid (17.4±2.6 and 11.4±1.6 mm Hg, p<0.001), serum amylase (774.3±233.9 and 472.7±168.6 U/L, p<0.001), procalcitonin (1.3±0.7 and 0.6±0.5 ng/mL, p<0.001) and interleukin-6 (531.3±120.9 and 417.1±82.4 pg/mL, p<0.001). Infectious complications developed in 50% of patients in the comparison group and 53.3% of patients in the main group (p>0.05).Conclusions. Early use of paracentesis of the abdominal cavity at the first stage in the treatment of patients with acute pancreatitis with enzymatic peritonitis leads to a significant decrease in the level of intra-abdominal pressure by 31%, procalcitonin by 32%, interleukin-6 by 12% and amylase 27% (p<0.001).