Oral Lactoferrin to Prevent Nosocomial Sepsis and Necrotizing Enterocolitis of Premature Neonates and Effect on T-Regulatory Cells
Oral Lactoferrin to Prevent Nosocomial Sepsis and Necrotizing Enterocolitis of Premature Neonates and Effect on T-Regulatory Cells
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DOI：
10.1055/s-0034-1371704
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发表时间：
2014-12-01
影响因子：
2
通讯作者：
Turmen, Tomris
中科院分区：
文献类型：
--
作者：
Akin, Ilke Mungan;Atasay, Begum;Turmen, Tomris
目的探讨乳铁蛋白（LF）对极低出生体重儿（VLBW）败血症的预防作用。调节性T细胞（T-regulatory cells，TCRs）是T淋巴细胞的重要亚群，控制病原体特异性免疫应答，对肠道免疫稳态至关重要。本研究的目的是确定200 mg/d剂量的口服LF是否减少早产儿的院内败血症发作和坏死性小肠结肠炎（NEC），并评估LF对Treg水平的可能影响。研究设计在该前瞻性、安慰剂对照、双盲、随机试验中，VLBW或32周前出生的婴儿被分配接受安慰剂（n = 25）、或200 mg LF（n = 25），每日一次。记录经培养证实的院内败血症和NEC的发生率。采用流式细胞仪检测出生和出院时FOXP 3 + CD 4 + CD 25 hi淋巴细胞水平。第三个比较与健康足月新生儿（n = 16）。结果观察到LF治疗的婴儿败血症发作较少（4.4 vs. 17.3/1，000患者日，p = 0.007），无NEC发生，无统计学意义。出生和出院时的Treg水平相似，而早产儿的水平显着低于足月对照组。结论LF预防性治疗可减少院内感染的发生。早产儿的Treg水平低于足月儿，并且观察到LF预防下Treg水平增加。调节性T细胞水平的增加可能是LF对医院感染的保护作用的机制。
Objective Lactoferrin (LF) is effective in the prevention of sepsis in very low birth weight (VLBW) neonates. T-regulatory cells (Tregs) are important subsets of T lymphocytes that control pathogen-specific immune responses and are essential for intestinal immune homoeostasis. The aim of the present study is to determine whether oral LF at a dosage of 200 mg/d reduces nosocomial sepsis episodes and necrotizing enterocolitis (NEC) in premature infants and to evaluate the possible effects of LF on Treg levels.Study Design In this prospective, placebo-controlled, double-blind, randomized trial, infants either VLBW or born before 32 weeks were assigned to receive either placebo (n = 25), or 200 mg LF (n = 25) daily throughout hospitalization. Episodes of culture proven nosocomial sepsis and NEC were recorded. The level of FOXP3 + CD4 + CD25hi lymphocytes was studied by flow cytometry at birth and discharge. A third comparison was made with healthy term neonates (n = 16).Results Fewer sepsis episodes were observed in LF-treated infants (4.4 vs. 17.3/1,000 patient days, p = 0.007) with none developing NEC, without statistical significance. Treg levels at birth and discharge were similar, while preterm infants showed significantly lower levels than term controls. However, individual increases in Treg levels were higher in the LF group.Conclusion LF prophylaxis reduced nosocomial sepsis episodes. Treg levels in preterm infants were lower than in term infants and an increase of Treg levels under LF prophylaxis was observed. Increase in Treg levels can be the mechanism for protective effects of LF on nosocomial sepsis.