Stephens R C M, Fidler K, Wilson P, Barclay G R, Mythen M G, Dixon G L J, Turner M W, Klein N J, Peters M J
Critical Care Group, Portex Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK.
Infectious Diseases & Microbiology Unit, Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK.
Intensive Care Med. 2006 Feb;32(2):286-294. doi: 10.1007/s00134-005-0019-z. Epub 2006 Feb 1.
The systemic inflammatory response syndrome (SIRS) may be triggered by endotoxin. Humans have antibodies directed against the core of endotoxin (endotoxin core antibodies, EndoCAb) that appear to be protective following surgery and in sepsis. We hypothesised that children with elevated antibodies to endotoxin core would be less likely to develop SIRS in their initial period on intensive care. Because of the existing literature we defined two sub-groups according to the primary reason for ICU admission: infection and non-infection.
We recruited 139 consecutive patients admitted to a paediatric intensive care unit (PICU) with more than one organ failure for longer than 12 h as part of another study. Patients were classified on admission to PICU as having an infectious or a non-infections diagnosis. The occurrence of SIRS within 48 h of admission was recorded along with detailed clinical and demographic data, EndoCAb concentration and the potential confounding variables C-reactive protein and mannose-binding lectin.
In the 71 patients admitted without infection (primarily post-operative and head injured) IgG EndoCAb was significantly lower in patients who developed SIRS than those who did not (72 vs. 131 MU/ml), independent of potential confounding variables. In patients with infection there was no significant difference in IgG EndoCAb between children developing SIRS and those who did not (111 vs. 80 MU/ml).
Head injured and post-operative patients admitted to PICU who develop early SIRS have significantly lower serum IgG EndoCAb levels than those who do not.
全身炎症反应综合征（SIRS）可能由内毒素触发。人类具有针对内毒素核心的抗体（内毒素核心抗体，EndoCAb），这些抗体在手术后和脓毒症中似乎具有保护作用。我们假设，内毒素核心抗体升高的儿童在重症监护初期发生SIRS的可能性较小。基于现有文献，我们根据入住重症监护病房（ICU）的主要原因定义了两个亚组：感染和非感染。
作为另一项研究的一部分，我们招募了139例连续入住儿科重症监护病房（PICU）、伴有多器官功能衰竭且持续时间超过12小时的患者。患者在入住PICU时被分类为患有感染性或非感染性诊断。记录入院后48小时内SIRS的发生情况，以及详细的临床和人口统计学数据、EndoCAb浓度以及潜在的混杂变量C反应蛋白和甘露糖结合凝集素。
在71例无感染入院的患者（主要为术后和头部受伤患者）中，发生SIRS的患者IgG EndoCAb显著低于未发生SIRS的患者（72 vs. 131 MU/ml），与潜在的混杂变量无关。在感染患者中，发生SIRS的儿童与未发生SIRS的儿童之间IgG EndoCAb无显著差异（111 vs. 80 MU/ml）。
入住PICU的头部受伤和术后患者若早期发生SIRS，其血清IgG EndoCAb水平显著低于未发生SIRS的患者。
