Personalized approach to acute peritonitis treatment based on genetic studies
DOI:
https://doi.org/10.34287/MMT.2(41).2019.20Abstract
The research presents treatment results of patients with peritonitis by using the personalized medicine principles, which are based on the choice of diagnostic, treatment and preventive measures taking in to account genetic, physiological, biochemical and other features of the patient.
Purpose of the study. The treatment results improvement of patients with peritonitis, the reduction of the complications frequency.
Materials and methods. 226 patients with signs of acute peritonitis had complex examination with serum cytokines and serotonin levels determination and analysis of the polymorphic sites alleles of IL1ß (-511C / T) and 5-HTTLPR genes by polymerase chain reaction evaluated the treatment outcomes using the developed algorithms. The treatment results with the use of developed algorithms were evaluated.
Results. The processes of peroxide oxidation, antioxidant protection, proteolysis, fibrinolytic activity and their role in systemic disorders of homeostasis are shown. The connection between the nature of inflammatory reactions, its distribution in the peritoneal cavity and variants of the IL1ß gene (-511C/T) was proved. The relationship between the character of intestinal motility disorders in the postoperative period and variants of the 5-HTTLPR gene, which regulates the serotoninergic mechanisms of intestinal contractility, is shown. The algorithms for personalized approach to the peritonitis diagnostics, prognosis of and choice of treatment tactics were developed on the basis of the identified genetically determined individual characteristics of the inflammatory process. Advanced stages of surgical intervention were developed.
Conclusion. Predictionofthecourseofperitonitis and the development of various complications based on genetic research allows developing algorithms of personalized therapeutic tactics, significantly improving the results of its treatment.
References
Kryvoruchko IA, Antonova MS. Clinical treatment patients of abdominal sepsis using sanation relaparotomy, considering the period of the abdominal cavity closure. Klinichna khirurhiya. 2015; 11 (2):16–18.
Dzyubanovskyy IY, Mihenko BO. The system antioxidant activity dynamics in patients with acute peritonitis disseminated. Klinichna ta eksperymentalna patolohiya. 2007; 6 (3): 38–40.
LyfshytsYZ, Zaychenko PA, Valetskyy VL et al. Laporostomy combined with vacuum therapy in the complex treatment of secondary generalized peritonitis. Khirurhiya Ukrayiny. 2012; 2: 37–40.
Boyko VV, Yvanova YV. The effect of cytokine oriented therapy on the incidence of purulent-septic complications and the survival of patients with postoperative peritonitis. Khirurhiya Ukrayiny. 2011; 2 (38): 54–59.
Kılıç E1, Uğur M, Yetim İ, Temiz M. Effects of temporary abdominal closure methods on mortality and morbidity in patients with open abdomen. Ulus Travma Aci lCerrahi Derg. 2018; 24 (4): 321–326. DOI: 10.5505/tjtes.2017.95038.
Tolonen M, Mentula P, Sallinen V et al. Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience. Trauma Acute Care Surg. 201; 82 (6): 1100–1105. DOI: 10.1097/TA.0000000000001452.
Utiyama EM, Pflug AR, Damous SH, Rodrigues AC Jr, Montero EF, Birolini CA.Temporary abdominal closure with zippermesh device for management of intra-abdominal sepsis. Rev Col Bras Cir. 201; 42 (1): 18–24.
Galli EG, Taietti C, Borghi M. Personalization of automated peritoneal dialysis treatment using a computer modeling system. Adv Perit Dial. 2011; 27: 90–96.
Jannasch O, Meyer F, Fuellert A et al. Vacuum-assisted closure (VAC) for postoperative secondary peritonitis: Effect on bacterial load as well as local and systemic cytokine response (initial results). Pol Przegl Chir. 2018; 90 (5): 27–35. DOI: 10.5604/01.3001.0012.1751.
Barnett RE, Keskey RC, Rao JM et al. Poor outcome in bacterial peritonitis is associated with dysregulated microRNAs and an increased inflammatory response. Surgery. 2013; 154 (3): 521–527. DOI: 10.1016/j.surg.2013.06.048.
Polianskyi IY, Grynchuk FV, Andriyets VV et al. Acute peritonitis classification. Klinichna anatomiya ta operatyvna khirurhiya. 2012; 11 (2): 68–70.
Moroz PV, Polianskyi IY. Predicting method occurrence of different forms of peritonitis in acute surgical pathology patients. Patent Ukrayiny 93421. 2014 ver. 25.
Maksymyuk VV, Polianskyi IY, Moskaliuk VI, Moroz PV Peritoneosorption method for the treatment of common forms of acute peritonitis. Patent Ukrayiny 93434. 2014 ver. 25.
Andriyets VV, Moskaliuk VI, Polianskyi IY, Moroz PV. Method of treating acute peritonitis. Patent Ukrayiny 117630. 2017 cher. 26.
Polianskyi IY, Hrynchuk FV, Maksymyuk VV. The sanation method of the peritoneal cavity with common forms of acute purulent peritonitis. Patent Ukrayiny 51921. 2002 hru. 16.
Polianskyi IY, Maksymyuk VV, Andriyets VV, Hrynchuk FV. The temporary closure method of the operation wound to perform programmed sanation of the abdominal cavity at purulent peritonitis common forms. Patent Ukrayiny 50931. 2002 hru. 15.
Moskaliuk VI. Genetic trigger neurohumoral messengers of postoperative intestinal paresis, its value inprediction, prevention and treatment. Evrika: Meditsinskiye nauki. 2016; 1: 14–19.
Polyanskyi I Yu, Moskaliuk II, Fediv OI, Moskaliuk VI. Predicting method for the onset of violations of the functional state of the intestine with combined pathology. Patent Ukrayiny 76483. 2013 sich. 10.
Polianskyi IY, Moskaliuk VI, Moskaliuk II, Andriyets' VV. Complex restoration method of motor-evacuation function of the intestine in postoperative motion of dynamic intestinal obstruction. Patent Ukrayiny 126856. 2018 lyp. 10.
