Nakamura Toshihiko, Hatanaka Daisuke, Kusakari Michiko, Kashima Kohei, Takizawa Yuji, Takahashi Hidehiro, Yoshioka Toshiro, Takahashi Naoto, Kamohara Takashi
Department of Neonatology, Japanese Red Cross Musashino Hospital.
Department of Pediatrics, National Organization Hospital, Nishi-Saitama Chuo National Hospital.
Tohoku J Exp Med. 2018 Feb;244(2):145-149. doi: 10.1620/tjem.244.145.
Leukemoid reaction (LR) is a reactive disease that exhibits abnormal blood values similar to leukemia, but not due to leukemia. One report showed that neonatal LR (NLR) was associated with elevated serum granulocyte colony stimulating factor (G-CSF) in only 30% of the study neonates. NLR is not always associated with the elevation of serum G-CSF. NLR was defined as a white blood cell count of ≥ 40 × 10/μL and/or blast cell concentration of > 2%. We have focused on NLR with fetal inflammatory response syndrome (FIRS), defined as a fetal systemic inflammatory reaction triggered by intrauterine infection. FIRS was diagnosed based on a cord serum interleukin-6 (IL-6) concentration ≥ 17.5 pg/mL and histopathological chorioamnionitis. Because NLR is highly associated with FIRS, we have hypothesized that NLR is associated with the elevation of both G-CSF and IL-6. This is the first report to measure multiple cytokines in NLR at the same time. The study comprised 19 preterm infants with FIRS: 8 with NLR (study group) and 11 without NLR (control group). Serum G-CSF and IL-6 concentrations were significantly higher in the study group than the control group. There was a positive correlation between G-CSF and IL-6 levels in the study group but not in the control group. These results suggest that elevated serum G-CSF and IL-6 may underlie NLR. Thus, G-CSF and IL-6 concentrations may be predictive of the onset of NLR. Measuring these cytokines is useful for judging the prognosis of preterm infants and for their post-natal clinical management.
类白血病反应（LR）是一种反应性疾病，其血液值异常类似于白血病，但并非由白血病引起。一份报告显示，在仅30%的研究新生儿中，新生儿类白血病反应（NLR）与血清粒细胞集落刺激因子（G-CSF）升高有关。NLR并不总是与血清G-CSF升高相关。NLR被定义为白细胞计数≥40×10⁹/μL和/或原始细胞浓度>2%。我们关注的是伴有胎儿炎症反应综合征（FIRS）的NLR，FIRS被定义为由宫内感染引发的胎儿全身性炎症反应。FIRS根据脐血血清白细胞介素-6（IL-6）浓度≥17.5 pg/mL和组织病理学绒毛膜羊膜炎进行诊断。由于NLR与FIRS高度相关，我们推测NLR与G-CSF和IL-6的升高均有关。这是首次同时测量NLR中多种细胞因子的报告。该研究包括19名患有FIRS的早产儿：8名患有NLR（研究组）和11名未患NLR（对照组）。研究组血清G-CSF和IL-6浓度显著高于对照组。研究组中G-CSF和IL-6水平呈正相关，而对照组中无此相关性。这些结果表明，血清G-CSF和IL-6升高可能是NLR的基础。因此，G-CSF和IL-6浓度可能预测NLR的发生。测量这些细胞因子有助于判断早产儿的预后及其出生后的临床管理。
