PLASMA CYTOKINE AND ENDOTOXIN LEVELS CORRELATE WITH SURVIVAL IN PATIENTS WITH THE SEPSIS SYNDROME
PLASMA CYTOKINE AND ENDOTOXIN LEVELS CORRELATE WITH SURVIVAL IN PATIENTS WITH THE SEPSIS SYNDROME
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DOI：
10.7326/0003-4819-119-8-199310150-00001
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发表时间：
1993-10-15
影响因子：
39.2
通讯作者：
BONE, RC
中科院分区：
文献类型：
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作者：
CASEY, LC;BALK, RA;BONE, RC
目的：为了确定血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-1 β当患者首次出现脓毒症综合征时，可检测到IL-1 β、IL-6和脂多糖，并确定其水平是否与患者生存相关。设计：前瞻性研究，比较脓毒症综合征患者、无脓毒症的危重患者和正常健康志愿者。患者：本研究包括97名符合脓毒症综合征标准的医疗服务连续患者; 20名在重症监护室的无脓毒症危重患者; 20名健康志愿者作为对照组。测量：当患者首次被确定为脓毒症综合征时，测量血浆肿瘤坏死因子-α、IL-1 β、白细胞介素-6和内毒素（脂多糖）水平。生存期定义为脓毒症综合征确诊后30天内存活。54%的脓毒症患者有可检测到的TNF-α水平（中位数，26 pg/mL;范围，无法检测到1000 pg/mL）; 37%的患者可检测到IL-1水平（中位数，20 pg/mL;范围，无法检测到2850 pg/mL）; 80%的患者可检测到IL-6水平（中位数，415 pg/mL;范围，不可检测到2380 pg/mL）; 89%的患者具有可检测水平的脂多糖（中位数，2.6;范围，不可检测到12.5内毒素单位[EU]/mL）。在所有情况下，水平高于无败血症的危重患者和正常健康对照组（所有比较P < 0.001）。无论培养状态如何，患者的TNF-α、IL-1 β、IL-6和脂多糖的血浆水平均可检测到。IL-6水平为69%。(95与存活患者相比，死亡患者的% CI高30%至108%。将TNF-α、IL-1 β、IL-6和脂多糖的各个水平的得分相加，得到总的脂多糖-细胞因子得分，并且死亡率随着脂多糖-细胞因子得分的增加而增加（P < 0.001）。结论：脓毒症综合征患者的循环TNF-α、IL-1、IL-6和脂多糖的水平可检测，与培养记录的感染无关。脂多糖和细胞因子可能在脓毒症中起致病作用，并且几种升高的因素的组合可能在决定患者存活方面是重要的。
Objective: To determine whether plasma tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), interleukin-6 (IL-6), and lipopolysaccharide are detectable in patients when they first present with the sepsis syndrome and to determine whether levels correlate with patient survival.Design: Prospective study comparing patients with the sepsis syndrome, critically ill patients without sepsis, and normal healthy volunteers.Setting: Tertiary care hospital affiliated with a medical school.Patients: The study included 97 consecutive patients on a medical service who met the criteria for the sepsis syndrome; 20 critically ill patients without sepsis who were in the medical intensive care unit; and 20 healthy volunteers who served as comparison groups.Measurements: Plasma tumor necrosis factor-alpha, IL-1beta, interleukin-6, and endotoxin (lipopolysaccharide) levels were measured when a patient was first identified as having the sepsis syndrome. Survival was defined as being alive 30 days after the sepsis syndrome was diagnosed.Results. Fifty-four percent of patients with the sepsis syndrome had detectable levels of TNF-alpha (median, 26 pg/mL; range, nondetectable to 1000 pg/mL); 37% had detectable levels of IL-1 (median, 20 pg/mL; range, nondetectable to 2850 pg/mL); 80% had detectable levels of IL-6 (median, 415 pg/mL; range, nondetectable to 2380 pg/mL); and 89% had detectable levels of lipopolysaccharide (median, 2.6; range, nondetectable to 12.5 endotoxin units [EU]/mL). In all cases, levels were higher than those in critically ill patients without sepsis and normal healthy controls (P < 0.001 for all comparisons). Plasma levels of TNF-alpha, IL-1beta, IL-6, and lipopolysaccharide were detectable in patients regardless of culture status. The IL-6 level was 69%. (95% CI, 30% to 108%) higher in patients who died compared with those who survived. The scores for the individual levels of TNF-alpha IL-1beta, IL-6, and lipopolysaccharide were summed to arrive at a total lipopolysaccharide-cytokine score, and mortality increased with lipopolysaccharide-cytokine score (P < 0.001).Conclusions: Patients with the sepsis syndrome have detectable levels of circulating TNF-alpha, IL-1, IL-6, and lipopolysaccharide independent of culture-documented infection. Lipopolysaccharide and cytokines may play a pathogenic role in sepsis, and the combination of several elevated factors may be important in determining patient survival.