Pathophysiologic and prognostic role of cytokines in dengue hemorrhagic fever
Pathophysiologic and prognostic role of cytokines in dengue hemorrhagic fever
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DOI：
10.1086/517807
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发表时间：
1998-03-01
影响因子：
6.4
通讯作者：
Kwiatkowski, D
中科院分区：
文献类型：
--
作者：
Bethell, DB;Flobbe, K;Kwiatkowski, D
登革休克综合征是登革出血热（DHF）的一种严重并发症，其特征是血管通透性大幅增加。对443名越南登革出血热患儿的血浆细胞因子浓度进行了前瞻性研究，其中6人死亡。188名患儿入院时已出现休克，71名患儿后来出现休克。与预期相反，某些炎症标志物（白细胞介素 - 6和可溶性细胞间黏附分子 - 1）在休克组中较低，这可能反映了由于毛细血管渗漏导致循环中蛋白质的普遍流失。只有可溶性肿瘤坏死因子受体（TNFR）水平与疾病严重程度呈一致的正相关，在疑似登革出血热无休克的患者中，可溶性肿瘤坏死因子受体 - 75（sTNFR - 75）入院水平超过55皮克/毫升可预测随后休克的发生，相对风险为5.5（95%置信区间，2.3 - 13.2）。可溶性肿瘤坏死因子受体的大量释放可能是导致登革休克综合征的内皮变化的早期特异性标志物。
Dengue shock syndrome is a severe complication of dengue hemorrhagic fever (DHF), characterized by a massive increase in vascular permeability. Plasma cytokine concentrations were prospectively studied in 443 Vietnamese children with DHF, of whom 6 died. Shock was present in 188 children on admission to hospital, and in 71 children it developed later. Contrary to expectations, certain inflammatory markers (interleukin-6 and soluble intercellular adhesion molecule-1) were lower in the group with shock, and this may reflect the general loss of protein from the circulation due to capillary leakage. Only soluble tumor necrosis factor receptor (TNFR) levels showed a consistent positive relationship with disease severity, in patients with suspected DHF without shock, admission levels of sTNFR-75 in excess of 55 pg/mL predicted the subsequent development of shuck, with a relative risk of 5.5 (95% confidence interval, 2.3-13.2). Large-scale release of soluble TNFR may be an early and specific marker of the endothelial changes that cause dengue shock syndrome.