The anti-inflammatory response dominates after septic shock:: association of low monocyte HLA-DR expression and high interleukin-10 concentration
The anti-inflammatory response dominates after septic shock:: association of low monocyte HLA-DR expression and high interleukin-10 concentration
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DOI：
10.1016/j.imlet.2004.07.009
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发表时间：
2004-09-01
影响因子：
4.4
通讯作者：
Lepape, A
中科院分区：
文献类型：
--
作者：
Monneret, G;Finck, ME;Lepape, A
单核细胞上HLA-DR表达的减少被认为是感染性休克时免疫抑制发生的可靠标志。本观察性研究的目的是在38例感染性休克成人患者中建立血浆细胞因子白细胞介素（IL）-10、转化生长因子（TGF）-β 1、肿瘤坏死因子（TNF）-α和单核细胞HLA-DR表达之间的时间依赖性关系。所有患者（28天死亡率：42%，平均入院SAPS II评分：54）HLA-DR表达降低。在所有时间点，这种表达在非幸存者中显著较低。所有患者的IL-10浓度均升高，最高值见于非存活者。IL-10是与HLA-DR表达显著相关的唯一细胞因子（r：-0.6，p < 0.001）。TNF和TGF值未提供任何预后信息。甚至发现来自脓毒症患者的TGF水平与正常值相比降低，这表明IL- 10可能比TGF在脓毒症患者血浆的免疫抑制性质方面更重要。这项初步工作表明，在全身水平上，抗炎反应在感染性休克后占主导地位。单核细胞HLADR表达和IL-10测量值得在更大的纵向研究中平行测定。它们可能构成对患者分期和决定是否采用能够逆转脓毒症诱导的免疫抑制的分子进行治疗的有用指标。由爱思唯尔公司出版
The diminished expression of HLA-DR on monocytes has been proposed as a reliable marker of immunosuppression occuring during septic shock. The objective of the present observational study was to establish the time-dependent relation between plasma cytokines interleukin (IL)-10, transforming growth factor (TGF)-beta1, tumor necrosis factor (TNF)-alpha and monocyte HLA-DR expression in 38 adult patients with septic shock. All patients (mortality at 28 days: 42%, mean admission SAPS II score: 54) had decreased HLA-DR expression. This expression was significantly lower in non-survivors at all time points. All patients had elevated IL-10 concentrations, the highest values were found in non-survivors. IL-10 was the sole cytokine to significantly correlate with HLA-DR expression (r: -0.6, p < 0.001). TNF and TGF values did not provide any prognostic information. TGF levels from septic patients were even found to be decreased in comparison with normal values which suggested that IL- 10 is likely more important than TGF regarding the immunosuppressive properties of septic patients' plasma. This preliminary work showed that, at the systemic level, the anti-inflammatory response dominated after septic shock. Monocyte HLADR expression and IL-10 measurement deserve to be determined in parallel in a larger longitudinal study. They might constitute helpful indicators for staging patients and making a decision about whether to institute a therapy with molecules able of reversing sepsis-induced immunosuppression. Published by Elsevier B.V.