Establishment of a new Severity Scoring System for the Patients with Multiple Organ Failure from the Aspect of Cellular Injury - Anoxic Necrosis and Apoptosis

多器官功能衰竭（MOF）仍然预后不良，是危重症患者死亡的首要原因。在MOF的治疗中，准确评估严重程度对于确定治疗方法、评估各种治疗的益处、预测结果以及在不太可能存活的患者中决定是否停止治疗非常重要。本研究旨在从缺氧坏死和细胞凋亡损伤的角度建立准确的MOF患者严重程度评分系统。我们开发并临床应用了细胞损伤评分（CIS），由3个细胞内代谢参数，动脉酮体比（AKBR），渗透压间隙（OG）和血乳酸来评估缺氧坏死引起的细胞损伤。我们对157例MOF患者和47例多器官功能障碍综合征（MODS）患者进行了CIS作为严重程度评分系统的临床评价，并与sep进行了比较。我们发现CDS很好地反映了MOF患者的严重程度和预后，CDS是临床上有用的严重程度评分系统。通过与SOFA评分的比较，我们发现CDS和SOFA在严重程度评价和死亡率预测方面具有可比性，对这两种严重程度评分系统进行顺序评价可以更准确地预测。然而，在一些接受长期治疗的患者中，CIS并不总是反映严重程度。细胞凋亡引起的细胞死亡可能参与这些患者器官衰竭的发展。我们检测MOF患者血浆中与凋亡相关的物质，如核基质蛋白、可溶性Fas配体和各种细胞因子，定量测定反映细胞凋亡的指标。然而，在本研究中，我们没有找到临床相关的评估细胞凋亡的物质，需要进一步的研究来建立一个临床有用的评估缺氧坏死和细胞凋亡的严重程度评分系统。少

Multiple organ failure (MOF) still has a poor prognosis and ranks at the top of the cause of death in critically ill patients. In the treatment of MOF, accurate evaluation of severity is important in determining therapeutic approach, assessing benefits of various treatments, predicting outcome and in decision making for withholding or withdrawal of treatments in patients who are unlikely to survive. This study was undertaken to establish the accurate severity scoring system for MOF patients from the aspect of cellular injury caused by anoxic necrosis and apoptosis. We have developed and clinically used cellular injury score (CIS), derived from 3 intracellular metabolic parameters, arterial ketone body ratio (AKBR), osmolality gap (OG) and blood lactate to evaluate the cellular injury caused by anoxic necrosis. We clinically evaluated the usefulness of CIS as the severity scoring system in 157 MOF patients and 47 multiple organ dysfunction syndrome (MODS) patients in comparison with sep … More sis-related organ failure assessment (SOFA) score. We found that CDS well reflected the severity and outcome of the MOF patients and that CDS is clinically useful severity scoring system. From the comparison with SOFA score, we found that CDS and SOFA are comparable for the evaluation of severity and for mortality prediction, and that sequential evaluation of these two severity scoring system would enable more accurate prediction. However, CIS does not always reflect severity in some patients received prolonged treatment. Cell death caused by apoptosis may involve in the development of organ failure in these patients. We investigated apoptosis related substances in plasma from MOF patients, such as nuclear matrix protein, soluble Fas ligand and various cytokines to determine the indices reflecting apoptosis quantitatively. However, we could not find clinically relevant substance for evaluation of apoptosis from this study Further study will be needed to establish a clinically useful severity scoring system evaluating both anoxic necrosis and apoptotis. Less