From the Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
ECMO Department, University of Michigan, Ann Arbor, Michigan.
ASAIO J. 2019 Jan;65(1):77-83. doi: 10.1097/MAT.0000000000000748.
Extracorporeal life support (ECLS) is a widely used lifesaving technology. Whether ECLS results in immune dysregulation is unclear. This study's aim was to examine whether ECLS affected innate immune response. All patients placed on ECLS were eligible. Blood was obtained before, during, and after ECLS. Function of the innate immune system was measured by ex vivo lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) and plasma cytokine levels (interleukin [IL]-6, IL-8, IL-10, and TNF-α). Immunoparalysis was defined as ex vivo TNF-α levels less than 200 pg/ml. Nineteen patients were enrolled with twelve <18 years old. Median ECLS duration was 10 days (range: 3-108); nine patients died. After stratifying the cohort by the presence of immunoparalysis before ECLS, those immunoparalyzed showed increased response to LPS on days 1 and 3 (p = 0.016). Those without pre-ECLS immunoparalysis showed a transient decrease in response on day 3 (p = 0.008). Plasma IL-10 levels were elevated in those with pre-ECLS immunoparalysis and dropped significantly by day 1 (p = 0.031). The number treated with steroids was similar in the two groups. In conclusion, patients with immunoparalysis before ECLS showed a gradual increase in immune function during ECLS, whereas those without immunoparalysis had a transient decrease in responsiveness on day 3.
体外生命支持 (ECLS) 是一种广泛应用的救生技术。ECLS 是否导致免疫失调尚不清楚。本研究旨在研究 ECLS 是否影响固有免疫反应。所有接受 ECLS 的患者均符合入选条件。在 ECLS 之前、期间和之后采集血液。通过体外脂多糖 (LPS) 诱导的肿瘤坏死因子-α (TNF-α) 和血浆细胞因子水平 (白细胞介素 [IL]-6、IL-8、IL-10 和 TNF-α) 来测量固有免疫系统的功能。免疫麻痹定义为体外 TNF-α 水平<200pg/ml。19 名患者入选，其中 12 名<18 岁。ECLS 持续时间中位数为 10 天 (范围：3-108)；9 名患者死亡。根据 ECLS 前是否存在免疫麻痹对队列进行分层后，免疫麻痹患者在第 1 天和第 3 天对 LPS 的反应增加 (p=0.016)。那些没有 ECLS 前免疫麻痹的患者在第 3 天反应短暂下降 (p=0.008)。在 ECLS 前存在免疫麻痹的患者中，血浆 IL-10 水平升高，并在第 1 天显著下降 (p=0.031)。两组中接受类固醇治疗的患者数量相似。总之，在 ECLS 前存在免疫麻痹的患者在 ECLS 期间免疫功能逐渐增强，而那些没有免疫麻痹的患者在第 3 天反应性短暂下降。
