Early adaptive immune suppression in children with septic shock: a prospective observational study.
Early adaptive immune suppression in children with septic shock: a prospective observational study.
复制标题
败血性休克儿童的早期适应性免疫抑制：一项前瞻性观察性研究。
DOI：
10.1186/cc13980
复制
发表时间：
2014-07-08
期刊：
影响因子：
--
通讯作者：
Hall MW
中科院分区：
文献类型：
--
作者：
Muszynski JA;Nofziger R;Greathouse K;Steele L;Hanson-Huber L;Nateri J;Hall MW
先天性免疫抑制通常发生在儿科危重病中，与不良结局相关。人们对败血症重症儿童的适应性免疫反应知之甚少。我们设计了一项单中心前瞻性观察性研究，以检验以下假设：与健康儿童相比，脓毒性休克儿童的适应性免疫功能下降，脓毒症儿童的适应性免疫功能下降与持续感染或新发医院感染的发生相关。因感染性休克（根据国际共识标准）入住儿科重症监护室的儿童（18岁或以下）入组本研究。在脓毒症发作后48小时内采集血样，并在疾病第7天再次采集血样。用离体植物血凝素（PHA）诱导的分离的CD 4 + T细胞的细胞因子产生能力评估适应性免疫功能。用流式细胞术测量调节性T细胞的百分比。如可用，记录绝对淋巴细胞计数。总共招募了22名感染性休克儿童和8名健康对照儿童。与健康儿童相比，感染性休克患儿发病第1 ~ 2天分离的CD 4 + T细胞经PHA刺激后产生的促炎细胞因子IFN-γ（P = 0.002）、促炎细胞因子IL-4（P = 0.03）和IL-10（P = 0.02）较少。在感染性休克儿童中，与未发生感染性休克的儿童相比，继续发生持续性或医院感染的儿童的T细胞体外PHA诱导的IFN-γ（P = 0.01）、IL-2（P = 0.01）、IL-4（P = 0.008）和IL-10（P = 0.001）的产生减少。调节性T细胞（CD 4 + CD 25 + CD 127 lo）的百分比在各组之间没有差异。适应性免疫抑制可能发生在儿科感染性休克的早期，并与感染相关的不良结局相关。
Innate immune suppression occurs commonly in pediatric critical illness, in which it is associated with adverse outcomes. Less is known about the adaptive immune response in critically ill children with sepsis. We designed a single-center prospective, observational study to test the hypothesis that children with septic shock would have decreased adaptive immune function compared with healthy children and that among children with sepsis, lower adaptive immune function would be associated with the development of persistent infection or new nosocomial infection. Children (18 years or younger) who were admitted to the pediatric intensive care unit with septic shock (by International Consensus Criteria) were enrolled in the study. Blood samples were taken within 48 hours of sepsis onset and again on Day 7 of illness. Adaptive immune function was assessed with ex vivo phytohemagglutinin (PHA)-induced cytokine production capacity of isolated CD4+ T cells. Percentage of regulatory T cells was measured with flow cytometry. Absolute lymphocyte counts were recorded when available. In total, 22 children with septic shock and eight healthy controls were enrolled. Compared with those from healthy children, CD4+ T cells isolated from septic shock children on Days 1 to 2 of illness and stimulated with PHA produced less of the pro-inflammatory cytokine interferon gamma (IFN-γ) (P = 0.002), and the antiinflammatory cytokines interleukin (IL)-4 (P = 0.03) and IL-10 (P = 0.02). Among septic shock children, those who went on to develop persistent or nosocomial infection had decreased T-cell ex vivo PHA-induced production of IFN-γ (P = 0.01), IL-2 (P = 0.01), IL-4 (P = 0.008), and IL-10 (P = 0.001) compared with septic shock children who did not. Percentage of regulatory T cells (CD4+CD25+CD127lo) did not differ among groups. Adaptive immune suppression may occur early in the course of pediatric septic shock and is associated with adverse infection-related outcomes.
登录
查看更多内容
影响因子：
8.8
作者：
Hall MW;Geyer SM;Guo CY;Panoskaltsis-Mortari A;Jouvet P;Ferdinands J;Shay DK;Nateri J;Greathouse K;Sullivan R;Tran T;Keisling S;Randolph AG;Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network PICFlu Study Investigators
通讯作者：
Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network PICFlu Study Investigators
影响因子：
120.7
作者：
Boomer, Jonathan S.;To, Kathleen;Chang, Kathy C.;Takasu, Osamu;Osborne, Dale F.;Walton, Andrew H.;Bricker, Traci L.;Jarman, Stephen D., II;Kreisel, Daniel;Krupnick, Alexander S.;Srivastava, Anil;Swanson, Paul E.;Green, Jonathan M.;Hotchkiss, Richard S.
通讯作者：
Hotchkiss, Richard S.
影响因子：
--
作者：
Hotchkiss, RS;Tinsley, KW;Karl, IE
通讯作者：
Karl, IE
影响因子：
9.6
作者：
Doughty, L;Carcillo, JA;Janosky, J
通讯作者：
Janosky, J
影响因子：
3.1
作者：
Parnell, Grant P.;Tang, Benjamin M.;McLean, Anthony S.
通讯作者：
McLean, Anthony S.