Marik P E, Zaloga G P
Department of Critical Care Medicine, Mercy Hospital of Pittsburgh, PA 15219-5166, USA.
J Am Geriatr Soc. 2001 Jan;49(1):5-9. doi: 10.1046/j.1532-5415.2001.49003.x.
As the proportion of the population that is older continues to rise, infection in older people has become an important healthcare problem. Although aging is associated with multiple abnormalities in immune function, the effect of aging on the production of proinflammatory cytokines has not been well studied under conditions of clinical stress.
The aim of this study was to examine the effect of aging on circulating levels of the proinflammatory cytokines in a large cohort of septic shock patients. We hypothesized that aging would be associated with a diminished proinflammatory cytokine response to sepsis.
Patients with septic shock who were enrolled in the placebo limb of the North American Sepsis Trial (NORASEPT II) study were analyzed.
The intensive care units of 105 hospitals in the United States and Canada.
Nine hundred and thirty patients presenting to hospital within 12 hours of the onset of septic shock.
Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), soluble tumor necrosis factor-receptor-55 (sTNF-R55), and soluble tumor necrosis factor-receptor-75 (sTNF-R75) concentrations were measured at enrollment. The study population was broken down into five age groups as follows: less than 50 years (group one), 50 to 64 years (group two), 65 to 74 years (group three), 75 to 84 years (group four), and 85 or older (group five). Clinical, demographic, and cytokine data were extracted to describe each age group.
Data were available for 930 patients. The patients' mean age (+/- SD) was 59 +/- 17 years (range, 18 to 102). There were 280 patients in group one, 242 in group two, 210 in group three, 150 in group four, and 48 in group five. The primary diagnoses; clinical characteristics; and IL-6, sTNF-R55, and sTNF-R75 levels were similar among the five age groups. The TNF-alpha levels were significantly higher, however, in the oldest group of patients (group five). The 28-day survival was 49% in patients over the age of 75 and 58% in those under 75 years (P = .03). There was no gender difference in survival or cytokine levels.
Contrary to our expectations, we found that aging was not associated with a decline in the circulating levels of proinflammatory cytokines.
随着老年人口比例持续上升，老年人感染已成为一个重要的医疗保健问题。尽管衰老与免疫功能的多种异常有关，但在临床应激条件下，衰老对促炎细胞因子产生的影响尚未得到充分研究。
本研究旨在探讨衰老对一大群感染性休克患者循环中促炎细胞因子水平的影响。我们假设衰老与对脓毒症的促炎细胞因子反应减弱有关。
对参加北美脓毒症试验（NORASEPT II）研究安慰剂组的感染性休克患者进行分析。
美国和加拿大105家医院的重症监护病房。
930例在感染性休克发作后12小时内入院的患者。
入组时测量白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、可溶性肿瘤坏死因子受体-55（sTNF-R55）和可溶性肿瘤坏死因子受体-75（sTNF-R75）的浓度。研究人群分为以下五个年龄组：小于50岁（第一组）、50至64岁（第二组）、65至74岁（第三组）、75至84岁（第四组）和85岁及以上（第五组）。提取临床、人口统计学和细胞因子数据以描述每个年龄组。
930例患者的数据可用。患者的平均年龄（±标准差）为59±17岁（范围18至102岁）。第一组有280例患者，第二组有242例，第三组有210例，第四组有150例，第五组有48例。五个年龄组的主要诊断、临床特征以及IL-6、sTNF-R55和sTNF-R75水平相似。然而，最年长的患者组（第五组）的TNF-α水平显著更高。75岁以上患者的28天生存率为49%，75岁以下患者为58%（P = 0.03）。生存率或细胞因子水平无性别差异。
与我们的预期相反，我们发现衰老与促炎细胞因子循环水平的下降无关。
