Immunophenotype predicts outcome in pediatric acute liver failure.
Immunophenotype predicts outcome in pediatric acute liver failure.
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DOI：
10.1097/mpg.0b013e31827a78b2
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发表时间：
2013-03
影响因子：
2.9
通讯作者：
Squires RH
中科院分区：
文献类型：
--
作者：
Bucuvalas J;Filipovich L;Yazigi N;Narkewicz MR;Ng V;Belle SH;Zhang S;Squires RH
我们试图确定T细胞免疫活化标志物，包括可溶性白细胞介素2受体α（sIL 2 R α）水平是否可预测儿科急性肝功能衰竭（PALF）的结局，并可能靶向免疫调节治疗的潜在候选者。我们分析了一项多国、多中心研究中77例PALF患者的免疫激活标志物。结果是在入组后21天内，自体肝、肝移植和未移植死亡的生存率。调整多重比较后，只有标准化的血清sIL 2 R α水平在3种结局之间存在显著差异，死亡（p= 0. 02）或接受肝移植（p= 0. 01）的患者显著高于使用自体肝脏存活的患者。37例sIL 2 R α水平正常的患者均存活，其中30例保留了原肝。15例sIL 2 R α明显升高（≥5000 IU/mL）的受试者中，5例用自体肝存活，2例死亡，8例接受肝移植。免疫激活的证据存在于一些死亡或接受肝移植的患者中。sIL 2 R α水平较高的患者比sIL 2 R α水平较低的患者更有可能在21天内死亡或接受肝移植。确定一个亚组的患者有不良结局的风险，可能会形成免疫调节药物的靶向临床试验的基础。
We sought to determine if markers of T cell immune activation, including soluble interleukin 2 receptor alpha (sIL2Rα) levels predict outcome in pediatric acute liver failure (PALF) and might target potential candidates for immunomodulatory therapy. We analyzed markers of immune activation in 77 patients with PALF enrolled in a multi-national, multi-center study. The outcomes were survival with native liver, liver transplantation, and death without transplantation within 21 days after enrollment. Adjusting for multiple comparisons, only normalized serum sIL2Rα level differed significantly among the 3 outcomes, and was significantly higher in patients who died (p=0.02) or underwent liver transplantation (p=0.01) compared to those who survived with their native liver. The 37 patients with normal sIL2Rα levels all lived, 30 with their native liver. Of the 15 subjects with markedly high sIL2Rα (≥5000 IU/mL), 5 survived with their native liver, 2 died, and 8 underwent liver transplantation. Evidence of immune activation is present in some patients who die or undergo liver transplantation. Patients with higher sIL2Rα levels were more likely to die or undergo liver transplantation within 21 days than those with lower levels. Identifying a subset of patients at risk for poor outcome may form the foundation for targeted clinical trials with immunomodulatory drugs.