Nanno Satoru, Koh Hideo, Katayama Takako, Hashiba Masamichi, Sato Ayumi, Makuuchi Yosuke, Nagasaki Joji, Kuno Masatomo, Yoshimura Takuro, Okamura Hiroshi, Nishimoto Mitsutaka, Hirose Asao, Nakamae Mika, Nakane Takahiko, Hino Masayuki, Nakamae Hirohisa
Hematology, Graduate School of Medicine, Osaka City University, Japan.
Intern Med. 2016;55(16):2173-84. doi: 10.2169/internalmedicine.55.6524. Epub 2016 Aug 15.
Objective Recent studies suggest that presepsin (soluble CD14-subtype) is a useful diagnostic and prognostic marker for sepsis, with secretion by activated macrophages potentially dependent on phagocytosis of microorganisms. As "hemophagocytosis" is one of the major characteristics in patients with hemophagocytic syndrome (HPS), we hypothesized that presepsin may reflect the phagocytic activity and be a useful prognostic marker for HPS. Therefore, we aimed to assess the prognostic potential of presepsin in secondary HPS in adult patients with hematological malignancies. Methods Between April 2006 and August 2014, we retrospectively examined consecutive patients with HPS whose blood samples were available at our institution and compared the prognostic value of the following in HPS, singly and in combination: plasma presepsin, serum soluble interleukin (IL)-2 receptor (sIL-2R), ferritin, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), IL-6 and IL-10. Results A total of 14 patients were enrolled. The median age of the patients was 46.5 years (range, 22-65). In univariable Cox models, there were no significant variables associated with the prognosis. However, in 12 evaluable patients, only the combination of higher median values of presepsin (>1,935 pg/mL) and sIL-2R (>4,585 U/mL) at the onset of HPS was significantly associated with the 90-day mortality (hazard ratio 14.5; 95% CI, 1.47-143.36; p=0.02). Conclusion These results suggest that a composite model of plasma presepsin and serum sIL-2R levels at the onset of HPS might be a novel predictor of the prognosis of patients with hematological malignancies and secondary HPS.
目的 近期研究表明，可溶性髓系细胞触发受体-1（可溶性CD14亚型）是脓毒症有用的诊断和预后标志物，其由活化巨噬细胞分泌可能依赖于微生物的吞噬作用。由于“噬血细胞现象”是噬血细胞综合征（HPS）患者的主要特征之一，我们推测可溶性髓系细胞触发受体-1可能反映吞噬活性，并且是HPS有用的预后标志物。因此，我们旨在评估可溶性髓系细胞触发受体-1在成年血液系统恶性肿瘤继发HPS患者中的预后潜力。方法 在2006年4月至2014年8月期间，我们回顾性研究了我院有血液样本的连续HPS患者，并比较了以下指标单独及联合应用时在HPS中的预后价值：血浆可溶性髓系细胞触发受体-1、血清可溶性白细胞介素（IL）-2受体（sIL-2R）、铁蛋白、肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）、IL-6和IL-10。结果 共纳入14例患者。患者的中位年龄为46.5岁（范围22 - 65岁）。在单变量Cox模型中，没有与预后相关的显著变量。然而，在12例可评估患者中，仅HPS发病时可溶性髓系细胞触发受体-1的中位值较高（>1935 pg/mL）和sIL-2R的中位值较高（>4585 U/mL）的联合与90天死亡率显著相关（风险比14.5；95%CI，1.47 - 143.36；p = 0.02）。结论 这些结果表明，HPS发病时血浆可溶性髓系细胞触发受体-1和血清sIL-2R水平的复合模型可能是血液系统恶性肿瘤继发HPS患者预后的新型预测指标。
