Hoffman William H, Burek C Lynne, Waller Jennifer L, Fisher Lyle E, Khichi Mahmood, Mellick Larry B
Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912, USA.
Clin Immunol. 2003 Sep;108(3):175-81. doi: 10.1016/s1521-6616(03)00144-x.
The objectives of this study were to monitor plasma cytokines as markers of cellular activation and as potential markers for the progression of the acute complications of diabetic ketoacidosis (DKA). Blood samples were obtained prior to, during and after treatment of severe DKA (pH < 7.2) in six children and adolescents. Plasma IL-10, IL-1beta, TNF-alpha, IL-6, IL-8 and IL-2 cytokine levels were assayed by ELISA at each of the time points. Prior to treatment, elevations of multiple cytokines were found, the highest being IL-10. Treatment of DKA resulted in a significant decrease of IL-10 at 6-8 h (p = 0.0062), and further increases in the inflammatory cytokines at 6-8 h and/or 24 h vs 120 h (baseline): IL-1beta (p =.0048); TNF-alpha (p =.0188) and IL-8 (p =.0048). This study strengthens the hypothesis that the metabolic crisis of DKA, and its treatment, have differential effects on cellular activation and cytokine release. The time frame for the increase in inflammatory cytokines correlates with the reported progression of subclinical brain edema, interstitial pulmonary edema and the development of clinical brain edema.
本研究的目的是监测血浆细胞因子，将其作为细胞活化的标志物以及糖尿病酮症酸中毒（DKA）急性并发症进展的潜在标志物。在对6名儿童和青少年的重度DKA（pH < 7.2）进行治疗之前、期间和之后采集血样。在每个时间点通过酶联免疫吸附测定法（ELISA）检测血浆白细胞介素-10（IL-10）、白细胞介素-1β（IL-1β）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）和白细胞介素-2（IL-2）细胞因子水平。治疗前发现多种细胞因子升高，其中最高的是IL-10。DKA治疗导致6 - 8小时时IL-10显著下降（p = 0.0062），并且与120小时（基线）相比，炎症细胞因子在6 - 8小时和/或24小时时进一步升高：IL-1β（p = 0.0048）；TNF-α（p = 0.0188）和IL-8（p = 0.0048）。本研究强化了以下假设：DKA的代谢危机及其治疗对细胞活化和细胞因子释放具有不同影响。炎症细胞因子升高的时间框架与所报道的亚临床脑水肿、间质性肺水肿的进展以及临床脑水肿的发生相关。
