Department of Internal Medicine, Tampere University Hospital, Box 2000, FI-33521 Tampere, Finland.
J Infect. 2012 Mar;64(3):276-81. doi: 10.1016/j.jinf.2011.12.006. Epub 2011 Dec 19.
Recent studies have shown that immunoparalysis and lymphocyte apoptosis play a critical role in severe bacteremia. Monitoring apoptosis on a routine basis in septic patients has proved challenging. We here studied the prognostic value of apoptosis markers human soluble Fas (sFas), Fas ligand (FasL) and sFas/FasL ratio in patients with bacteremia.
sFas (ng/ml) and FasL (ng/ml) concentrations in plasma were determined using commercial quantitative enzyme immunoassays (Quantikine®, R&D Systems Inc., Minneapolis, MN, USA) in 132 patients with bacteremia caused by Staphylococcus aureus, Streptococcus pneumoniae, β-hemolytic streptococcae or Escherichia coli.
Maximum sFas, minimum FasL and high sFas/FasL ratio predicted high SOFA score in bacteremic patients (p < 0.001, p = 0.003 and p < 0.001, respectively). AUC(ROC)'s in the prediction of high SOFA score for sFas, FasL and sFas/FasL ratio were 0.70 (CI 0.61-0.79), 0.65 (CI 0.56-0.75) and 0.72 (CI 0.63-0.80), respectively. High sFas concentrations and sFas/aFasL ratio, assessed using ROC curve as regards high SOFA (≥4) score, were associated with hypotension (p = 0.001 and p = 0.039, respectively). All of these markers predicted a high SOFA score independently in a logistic regression model. Maximum sFas, sFas/FasL ratio or minimum FasL during days 1-4 after blood culture were not associated with increased case fatality.
Apoptosis markers sFas, FasL or sFas/FasL ratio are associated with high SOFA score in bacteremia.
最近的研究表明，免疫麻痹和淋巴细胞凋亡在严重菌血症中起着关键作用。在脓毒症患者中常规监测凋亡一直具有挑战性。我们在此研究了凋亡标志物人可溶性 Fas（sFas）、Fas 配体（FasL）和 sFas/FasL 比值在菌血症患者中的预后价值。
使用商业定量酶联免疫吸附测定法（Quantikine®，R&D Systems Inc.，明尼苏达州明尼阿波利斯，美国）测定 132 例由金黄色葡萄球菌、肺炎链球菌、β-溶血性链球菌或大肠杆菌引起菌血症患者的血浆中 sFas（ng/ml）和 FasL（ng/ml）浓度。
最大 sFas、最小 FasL 和高 sFas/FasL 比值预测菌血症患者 SOFA 评分较高（p<0.001、p=0.003 和 p<0.001）。sFas、FasL 和 sFas/FasL 比值预测 SOFA 评分较高的 AUC（ROC）分别为 0.70（CI 0.61-0.79）、0.65（CI 0.56-0.75）和 0.72（CI 0.63-0.80）。使用 ROC 曲线评估高 SOFA（≥4）评分时，高 sFas 浓度和 sFas/aFasL 比值与低血压相关（p=0.001 和 p=0.039）。在逻辑回归模型中，所有这些标志物均可独立预测 SOFA 评分较高。血培养后 1-4 天的最大 sFas、sFas/FasL 比值或最小 FasL 与病死率增加无关。
凋亡标志物 sFas、FasL 或 sFas/FasL 比值与菌血症患者的 SOFA 评分较高相关。
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