[血清肿瘤坏死因子-α、白细胞介素-10、瘦素及C反应蛋白水平在新生儿败血症中的预后价值]

[Prognostic value of serum TNF-alpha, IL-10, leptin and CRP levels in newborns with septicemia].

作者信息

Cesur Salih, Irmak Hasan, Eras Zeynep, Yaşar Handan, Sengül Ali, Dilmen Uğur, Demiröz Ali Pekcan, Biyikli Zeynep, Ilikçi Rahşan

机构信息

Ankara Eğitim ve Araştirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Kliniği, Ankara.

出版信息

Mikrobiyol Bul. 2009 Oct;43(4):607-12.

PMID:20084913

Abstract

This study was aimed to investigate the prognostic value of tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), leptin and C-reactive protein (CRP) levels in newborn sepsis. A total of 57 newborns with nosocomial sepsis and 30 healthy newborns were included to the study. Serum TNF-alpha, IL-10, leptin (Biosource, Belgium) and CRP (Dade Behring, Germany) levels were investigated by ELISA methodology before the initiation of the therapy (day 0) and on the third and fifth days of therapy. Initial leptin levels were found to be high in the control group (p = 0.00) and CRP levels were found to be high in the patient group (p = 0.00). No significant difference was detected for IL-10 and TNF-alpha levels (p > 0.05). CRP levels were significantly higher in the patient group than the controls on the third day of the therapy (p = 0.001), however, no significant difference was detected for the other parameters (p > 0.05). On the fifth day of the therapy CRP (p = 0.023) and leptin (p = 0.00) levels were significantly high in the patient group and TNF-alpha in the control group (p = 0.00) while no significant difference was observed for IL-10 levels (p > 0.05). Mortality rate was 24.5%. When the mean TNF-alpha, IL-10, leptin and CRP levels on the 0th, 3rd and 5th days were analysed for alive (n = 43) and dead (n = 14) newborns with sepsis, it was observed that TNF-alpha, IL-10 and CRP levels were related with poor prognosis (p < 0.05). The ROC analysis performed for the determination of the prognostic performance of TNF-alpha and IL-10 revealed that these parameters had predictive value about mortality when their levels were above certain cut-off values (on the 5th day of therapy for IL-10 > 1.8 ng/ml and for TNF-alpha > 21.1 ng/ml). It can be concluded that besides routine laboratory parameters, serum TNF-alpha and IL-10 levels at the initiation of therapy and afterwards may help to predict prognosis and guide treatment in newborns with sepsis.

摘要

本研究旨在探讨肿瘤坏死因子-α（TNF-α）、白细胞介素-10（IL-10）、瘦素和C反应蛋白（CRP）水平在新生儿败血症中的预后价值。共有57例医院感染性败血症新生儿和30例健康新生儿纳入本研究。采用酶联免疫吸附测定（ELISA）方法在治疗开始前（第0天）以及治疗的第3天和第5天检测血清TNF-α、IL-10、瘦素（比利时Biosource公司）和CRP（德国Dade Behring公司）水平。发现对照组初始瘦素水平较高（p = 0.00），患者组CRP水平较高（p = 0.00）。未检测到IL-10和TNF-α水平有显著差异（p > 0.05）。治疗第3天患者组CRP水平显著高于对照组（p = 0.001），然而，其他参数未检测到显著差异（p > 0.05）。治疗第5天，患者组CRP（p = 0.023）和瘦素（p = 0.00）水平显著升高，对照组TNF-α水平显著升高（p = 0.00），而IL-10水平未观察到显著差异（p > 0.05）。死亡率为24.5%。分析败血症存活（n = 43）和死亡（n = 14）新生儿第0天、第3天和第5天TNF-α、IL-10、瘦素和CRP的平均水平，发现TNF-α、IL-10和CRP水平与预后不良相关（p < 0.05）。为确定TNF-α和IL-10的预后性能进行ROC分析，结果显示当这些参数水平高于特定临界值时（治疗第5天IL-10 > 1.8 ng/ml，TNF-α > 21.1 ng/ml），它们对死亡率具有预测价值。可以得出结论：除常规实验室参数外，治疗开始时及之后的血清TNF-α和IL-10水平可能有助于预测新生儿败血症预后并指导治疗。