Department of Pediatrics, Wayne State University, Detroit, Michigan, USA.
Pediatr Res. 2012 Aug;72(2):212-20. doi: 10.1038/pr.2012.56.
Information on cytokine profiles in fungal sepsis (FS), an important cause of mortality in extremely low birthweight (ELBW) infants, is lacking. We hypothesized that cytokine profiles in the first 21 d of life in ELBW infants with FS differ from those with bacterial sepsis (BS) or no sepsis (NS).
In a secondary analysis of the National Institute of Child Health and Human Development Cytokine study, three groups were defined-FS (≥1 episode of FS), BS (≥1 episode of BS without FS), and NS. Association between 11 cytokines assayed in dried blood spots obtained on days 0-1, 3 ± 1, 7 ± 2, 14 ± 3, and 21 ± 3 and sepsis group was explored.
Of 1,066 infants, 89 had FS and 368 had BS. As compared with BS, FS was more likely to be associated with lower birthweight, vaginal delivery, patent ductus arteriosus, postnatal steroids, multiple central lines, longer respiratory support and hospital stay, and higher mortality (P < 0.05). Analyses controlling for covariates showed significant group differences over time for interferon-γ (IFN-γ), interleukin (IL)-10, IL-18, transforming growth factor-β (TGF-β), and tumor necrosis factor-α (TNF-α) (P < 0.05).
Significant differences in profiles for IFN-γ, IL-10, IL-18, TGF-β, and TNF-α in FS, BS, or NS in this hypothesis-generating secondary study require validation in rigorously designed prospective studies and may have implications for diagnosis and treatment.
真菌性败血症（FS）是极低出生体重（ELBW）婴儿死亡的重要原因，有关其细胞因子谱的信息尚缺乏。我们假设，FS、细菌性败血症（BS）和无败血症（NS）的 ELBW 婴儿在生命最初 21 天的细胞因子谱不同。
本研究为国立儿童健康与人类发展研究所细胞因子研究的二次分析，定义了三组：FS（≥1 次 FS 发作）、BS（≥1 次无 FS 的 BS 发作）和 NS。探索了在第 0-1、3±1、7±2、14±3 和 21±3 天获得的干血斑中检测到的 11 种细胞因子与败血症组之间的关联。
在 1066 名婴儿中，89 例 FS 和 368 例 BS。与 BS 相比，FS 更可能与较低的出生体重、阴道分娩、动脉导管未闭、产后类固醇、多条中央静脉置管、更长的呼吸支持和住院时间以及更高的死亡率相关（P＜0.05）。在控制协变量的分析中，IFN-γ（IFN-γ）、白细胞介素（IL）-10、IL-18、转化生长因子-β（TGF-β）和肿瘤坏死因子-α（TNF-α）在时间上有显著的组间差异（P＜0.05）。
本假设生成的二次研究中，FS、BS 或 NS 中 IFN-γ、IL-10、IL-18、TGF-β 和 TNF-α 的谱存在显著差异，需要在严格设计的前瞻性研究中进行验证，这可能对诊断和治疗有影响。
