Ng Pak C, Li Karen, Leung Ting F, Wong Raymond P O, Li Geng, Chui Kit M, Wong Eric, Cheng Frankie W T, Fok Tai F
Department of Pediatrics, Center of Epidemiology and Biostatistics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
Clin Chem. 2006 Jun;52(6):1181-9. doi: 10.1373/clinchem.2005.062075. Epub 2006 Apr 13.
The progression to disseminated intravascular coagulation (DIC) in infected very low birth weight (VLBW; <1500 g) infants is difficult to predict with precision at the onset of sepsis. We investigated the immunologic profiles of preterm infants with sepsis, using chemokine and cytokine measurements to predict the development of sepsis-induced DIC at the onset of infection.
We measured a panel of chemokines and cytokines at 0 and 24 h after clinical presentation in VLBW infants with suspected infection requiring full sepsis screening. The chemokines measured were interleukin (IL)-8, interferon-gamma-inducible protein-10 (IP-10), monokine induced by interferon-gamma, monocyte chemoattractant protein-1, and regulated upon activation normal T-cell expressed and secreted (RANTES), and the cytokines were IL-6, IL-10, and tumor necrosis factor-alpha.
Of 195 episodes of suspected clinical sepsis investigated, 62 were culture-confirmed septicemia or necrotizing enterocolitis (28 of these infants developed DIC), 22 were culture-negative clinical infections, and 111 involved noninfected episodes. All studied inflammatory mediators except RANTES showed significantly greater up-regulation in culture-positive infected infants than in noninfected infants at 0 and 24 h, whereas RANTES showed significant down-regulation. The model that used plasma IL-10 (>208 ng/L), IL-6 (>168 ng/L), and RANTES (<3110 ng/L) at 0 h had sensitivity, specificity, and positive and negative predictive values of 100%, 97%, 85%, and 100%, respectively, for identifying infected patients who subsequently developed DIC.
IL-10, IL-6, and RANTES measured at clinical presentation sensitively and accurately predicted the development of DIC in severely infected infants. This information could be vital for early and effective treatment of neonatal sepsis.
感染的极低出生体重（VLBW；<1500g）婴儿进展为弥散性血管内凝血（DIC），在脓毒症发作时很难精确预测。我们研究了脓毒症早产儿的免疫特征，通过检测趋化因子和细胞因子来预测感染发作时脓毒症诱导的DIC的发生。
我们在需要进行全面脓毒症筛查的疑似感染的极低出生体重婴儿临床表现后的0小时和24小时测量了一组趋化因子和细胞因子。检测的趋化因子有白细胞介素（IL）-8、γ干扰素诱导蛋白10（IP-10）、γ干扰素诱导的单核因子、单核细胞趋化蛋白-1以及活化正常T细胞表达和分泌调节因子（RANTES），细胞因子有IL-6、IL-10和肿瘤坏死因子-α。
在195例疑似临床脓毒症发作中，62例为血培养确诊的败血症或坏死性小肠结肠炎（其中28例婴儿发生了DIC），22例为血培养阴性的临床感染，111例为非感染发作。除RANTES外，所有研究的炎症介质在0小时和24小时时，血培养阳性的感染婴儿比未感染婴儿上调明显更显著，而RANTES表现为显著下调。在0小时使用血浆IL-10（>208ng/L）、IL-6（>168ng/L）和RANTES（<3110ng/L）的模型对于识别随后发生DIC的感染患者，其敏感性、特异性、阳性预测值和阴性预测值分别为100%、97%、85%和100%。
临床表现时测量的IL-10、IL-6和RANTES能敏感且准确地预测严重感染婴儿DIC的发生。该信息对于新生儿脓毒症的早期和有效治疗可能至关重要。
