CORRELATION OF PLASMA CYTOKINE ELEVATIONS WITH MORTALITY-RATE IN CHILDREN WITH SEPSIS
CORRELATION OF PLASMA CYTOKINE ELEVATIONS WITH MORTALITY-RATE IN CHILDREN WITH SEPSIS
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DOI：
10.1016/s0022-3476(05)82476-x
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发表时间：
1992-04-01
影响因子：
5.1
通讯作者：
HARRIS, MC
中科院分区：
文献类型：
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作者：
SULLIVAN, JS;KILPATRICK, L;HARRIS, MC
细胞因子被认为是宿主对细菌感染的免疫反应的重要内源性介质。我们假设脓毒症儿童的血浆细胞因子水平升高，并且这些细胞因子升高的程度与疾病的严重程度和死亡率相关。我们测定了 21 名脓毒症儿童的血浆肿瘤坏死因子、白细胞介素 6 和白细胞介素 1 水平。在就诊时及其后 12、24 和 48 小时收集血浆样本。细菌性败血症儿科患者在发病后 48 小时内细胞因子水平升高；在研究对照受试者中检测不到水平。非幸存者中的肿瘤坏死因子和白细胞介素 6 水平 (p < 0.001) 以及白细胞介素 1 水平 (p = 0.05) 显着高于幸存者，并且与就诊时疾病的严重程度（儿科死亡风险 (PRISM) 评分）无关。非幸存者中肿瘤坏死因子和白细胞介素 6 的升高持续超过 24 至 48 小时； II-1 浓度仅在零时间显着增加。在最初 48 小时内，白细胞介素 6 值大于 2 ng/ml 的 11 名儿童中，有 10 人死亡；未达到该水平的 10 个人中只有 1 个人死亡 (p < 0.001)。革兰氏阳性菌和革兰氏阴性菌感染时细胞因子升高的频率相同。我们推测细胞因子测定可以识别可能受益于免疫治疗干预的儿童。
Cytokines are thought to be important endogenous mediators of the host immune response to bacterial infection. We hypothesized that plasma levels of cytokines are elevated in children with sepsis and that the magnitude of elevation of these cytokines is correlated with severity of illness and mortality rate. We determined plasma levels of tumor necrosis factor, interleukin-6, and interleukin-1 in 21 children with sepsis. Plasma samples were collected at presentation and at 12, 24, and 48 hours thereafter. Cytokine levels were elevated in pediatric patients with bacterial sepsis during the first 48 hours after presentation; levels were undetectable in study control subjects. The tumor necrosis factor and interleukin-6 levels (p < 0.001), as well as levels of interleukin-1 (p = 0.05), were significantly higher in nonsurvivors than in survivors and were independent of severity of illness (pediatric risk of mortality (PRISM) score) at presentation. Elevations of tumor necrosis factor and interleukin-6 were sustained for longer than 24 to 48 hours in nonsurvivors; II-1 concentrations were significantly increased only at time zero. Of 11 children with an interleukin-6 value greater than 2 ng/ml during the first 48 hours, 10 died; only one of 10 not reaching that level died (p < 0.001). Cytokines were elevated as frequently with gram-positive as with gram-negative infections. We speculate that cytokine determinations may identify children who might benefit from immunotherapeutic interventions.