评估BCL2和TNFα作为监测危重症儿童免疫反应的mRNA生物标志物。
Evaluation of BCL2 and TNFα as mRNA biomarkers for monitoring the immune response in critically ill children.
作者信息
El Shazly Ahmed Nabih, Soliman Doaa Refaey, Mohammed Shuzan Ali, Zakaria Rasha Mohammed, Awais Fatma Elzahraa Mohammed
机构信息
Department of Pediatrics, Faculty of Medicine, Benha University, Benha, Qualubia, Egypt.
Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Benha University, Benha, Qualubia, Egypt.
出版信息
Ann Med Surg (Lond). 2018 Oct 30;36:122-128. doi: 10.1016/j.amsu.2018.10.024. eCollection 2018 Dec.
BACKGROUND
Hospital acquired infection (HAI) and multiple organ dysfunctions (MODS) remain a leading cause of death in pediatric intensive care unit (PICU) despite the great efforts to control it.
OBJECTIVE
Our objective was to assess the mRNA of TNFα and BCL2 for prediction of HAI and/or MODS in our community.
PATIENTS AND METHODS
Fifty children, admitted to PICU, were included in the study after exclusion of cases of end-stage renal failure, end-stage liver failure and congenital immune deficiency. Serial Blood samples were collected for complete blood count (CBC) and other routine investigations. Gene expression of (TNFα and BCL2) was quantified using quantitative real time PCR (qRT-PCR). Centers of disease control (CDC) criteria were used to detect HAI, and organ failure index (OFI). Pediatric logistic organ dysfunction (PELOD) and pediatric risk of mortality (PRISM) scores were used for follow up. The results were compared between the group who acquired HAI and who didn't. Gene expression was tested with a ROC curve to detect its ability to predict HAI.
MAIN RESULTS
The overall complication (HAI and/or MODS) rate was 52%, Complicated cases had a significantly longer duration of stay in PICU (0.002) and in overall hospital stay (p = 0.013) and a higher death rate (p = 0.000). On day1; TNFα, BCL2 and lymphocytic count were lower in patients who developed complications (p = 0.02, p = 0.000 and p = 0.04, respectively), all had the ability to predict the complications with AUC (0.7, 0.8 and 0.67 respectively). On day 4: TNFα and BCL2 returned to normal levels while the lymphocytic count still lower in complicated cases, p = 0.001 and AUC = 0.73.
CONCLUSIONS
TNFα and BCL2 on admission can predict HAI and MODS (AUC = 0.7 and AUC = 0.8), but were of no use in the follow-up, however, the lymphocytic count is a rapid, easy and cheap test to assess the immune state with a good predictive and follow up values.
背景
尽管在控制医院获得性感染（HAI）和多器官功能障碍（MODS）方面付出了巨大努力，但它们仍是儿科重症监护病房（PICU）死亡的主要原因。
目的
我们的目的是评估TNFα和BCL2的mRNA，以预测我们社区中的HAI和/或MODS。
患者与方法
纳入50名入住PICU的儿童，排除终末期肾衰竭、终末期肝功能衰竭和先天性免疫缺陷病例。采集系列血样进行全血细胞计数（CBC）和其他常规检查。使用定量实时PCR（qRT-PCR）对（TNFα和BCL2）的基因表达进行定量。采用疾病控制中心（CDC）标准检测HAI和器官衰竭指数（OFI）。使用儿科逻辑器官功能障碍（PELOD）和儿科死亡风险（PRISM）评分进行随访。比较发生HAI组和未发生HAI组的结果。用ROC曲线测试基因表达预测HAI的能力。
主要结果
总体并发症（HAI和/或MODS）发生率为52%，并发症患儿在PICU的住院时间（0.002）和总体住院时间（p = 0.013）显著延长，死亡率更高（p = 0.000）。在第1天，发生并发症的患者中TNFα、BCL2和淋巴细胞计数较低（分别为p = 0.02、p = 0.000和p = 0.04），三者均有预测并发症的能力，AUC分别为（0.7、0.8和0.67）。在第4天：TNFα和BCL2恢复正常水平，而并发症患儿的淋巴细胞计数仍较低，p = 0.001，AUC = 0.73。
结论
入院时TNFα和BCL2可预测HAI和MODS（AUC = 0.7和AUC = 0.8），但在随访中无用，然而，淋巴细胞计数是评估免疫状态的一种快速、简便且廉价的检测方法，具有良好的预测和随访价值。
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