Butthep Punnee, Chunhakan Sirichan, Tangnararatchakit Kanchana, Yoksan Sutee, Pattanapanyasat Kovit, Chuansumrit Ampaiwan
Department of Pathology, Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand.
Pediatr Infect Dis J. 2006 Oct;25(10):894-7. doi: 10.1097/01.inf.0000237918.85330.b9.
Children with dengue hemorrhagic fever (DHF) are at risk to develop dengue shock syndrome (DSS) for which neither marker has been demonstrated.
The study was designed to investigate the markers of vascular endothelial cell injuries and dysfunction that might be used as early predictors of the subsequent manifestation of DSS.
The blood samples from 111 patients with dengue fever, DHF and other febrile illness (OFI) were collected daily from the day of admission until discharge and at convalescent stage. The sample from the day of defervescence was defined as day 0, 1 day before defervescence was defined as day -1 and so on. Also, 1 day after defervescence was defined as day +1 and so on.
Increased soluble thrombomodulin (sTM) was demonstrated in dengue-infected patients via an enzyme-linked immunosorbent assay. Patients with DSS (DHF grades III and IV) had higher concentrations of sTM than those with dengue fever, DHF grade I, II and OFIs from day -3 until day +2. Increased circulating endothelial cells were detected from day 0 until day +2 in DSS patients as compared with other groups. In addition, increased soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and soluble E-selectin were also found in dengue virus-infected patients as compared with OFIs.
Blood sTM may be useful as an early predictor of DSS in dengue infected patients in the febrile stage. However, a further evaluation in a large prospective series is needed.
登革出血热（DHF）患儿有发展为登革休克综合征（DSS）的风险，而目前尚未证实有可用于预测DSS的标志物。
本研究旨在调查血管内皮细胞损伤和功能障碍的标志物，这些标志物可能作为DSS后续表现的早期预测指标。
从111例登革热、DHF和其他发热性疾病（OFI）患者入院当天至出院及恢复期，每天采集血样。退热当天的样本定义为第0天，退热前1天定义为第-1天，依此类推。此外，退热后1天定义为第+1天，依此类推。
通过酶联免疫吸附测定法显示，登革热感染患者的可溶性血栓调节蛋白（sTM）升高。从第-3天到第+2天，DSS患者（DHF III级和IV级）的sTM浓度高于登革热、DHF I级、II级患者及OFI患者。与其他组相比，DSS患者从第0天到第+2天检测到循环内皮细胞增加。此外，与OFI患者相比，登革病毒感染患者的可溶性血管细胞黏附分子-1、可溶性细胞间黏附分子-1和可溶性E选择素也增加。
血液sTM可能作为登革热感染患者发热期DSS的早期预测指标。然而，需要在大型前瞻性系列研究中进行进一步评估。
