Sánchez Jorge L, Salgado Doris M, Vega Martha Rocío, Castro-Trujillo Sebastián, Narváez Carlos F
División de Inmunología, Programa de Medicina, Facultad de Ciencias de la Salud, Universidad Surcolombiana, Neiva 41001, Colombia.
Departamento de Pediatría, Universidad Surcolombiana, Hospital Universitario de Neiva, Neiva 41001, Colombia.
J Trop Pediatr. 2024 Jul 13;70(4). doi: 10.1093/tropej/fmae014.
Dengue is a significant health problem due to the high burden of critical infections during outbreaks. In 1997, the World Health Organization (WHO) classified dengue as dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). It was revised in 2009 (updated in 2015), and the new guidelines recommended classifying patients as dengue without warning signs (DNS), dengue with warning signs (DWS), and severe dengue (SD). Although the utility of the revised 2009 classification for clinical studies is accepted, for immunological studies it needs to be clarified. We determined the usefulness of the 2009 classification for pediatric studies that analyze the circulating interleukin (IL)-6 and IL-8, two inflammatory cytokines. Plasma levels of IL-6 and IL-8 were evaluated in the acute and convalescent phases by flow cytometry in children with dengue classified using the 1997 and 2009 WHO guidelines. The plasma levels of IL-6 and IL-8 were elevated during the acute and decreased during convalescence, and both cytokines served as a good marker of acute dengue illness compared to convalescence. There were no differences in the plasma level of the evaluated cytokines among children with different clinical severity with any classification, except for the IL-8, which was higher in DWS than DNS. Based on the levels of IL-8, the 2009 classification identified DWS plus SD (hospital-treated children) compared to the DNS group [area under the curve (AUC): 0.7, p = 0.028]. These results support the utility of the revised 2009 (updated in 2015) classification in studies of immune markers in pediatric dengue.
由于疫情期间严重感染的负担沉重，登革热成为一个重大的健康问题。1997年，世界卫生组织（WHO）将登革热分为登革热（DF）、登革出血热（DHF）和登革休克综合征（DSS）。2009年（2015年更新）对其进行了修订，新指南建议将患者分为无警示体征登革热（DNS）、有警示体征登革热（DWS）和重症登革热（SD）。尽管修订后的2009年分类法在临床研究中的实用性得到认可，但在免疫学研究中仍需进一步明确。我们确定了2009年分类法在分析循环白细胞介素（IL）-6和IL-8这两种炎性细胞因子的儿科研究中的实用性。采用1997年和2009年WHO指南对登革热患儿进行分类，通过流式细胞术在急性期和恢复期评估IL-6和IL-8的血浆水平。IL-6和IL-8的血浆水平在急性期升高，恢复期下降，与恢复期相比，这两种细胞因子都是急性登革热疾病的良好标志物。除IL-8在DWS中高于DNS外，不同临床严重程度的患儿在任何分类中评估的细胞因子血浆水平均无差异。基于IL-8水平，与DNS组相比，2009年分类法识别出了DWS加SD（住院治疗患儿）[曲线下面积（AUC）：0.7，p = 0.028]。这些结果支持了2009年（2015年更新）修订分类法在儿科登革热免疫标志物研究中的实用性。
