López E L, Contrini M M, Devoto S, de Rosa M F, Graña M G, Genero M H, Canepa C, Gomez H F, Cleary T G
Unit 9, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina.
Pediatr Infect Dis J. 1995 Jul;14(7):594-8. doi: 10.1097/00006454-199507000-00008.
Hemolytic uremic syndrome (HUS) is thought to be a vascular endothelial injury disease. The mechanism of injury is unknown although verocytotoxins (Shiga-like toxins (SLTs)) are known to be associated with it. Recent evidence suggests that in vitro treatment of some endothelial cells with tumor necrosis factor alpha (TNF-alpha) dramatically increases their susceptibility to SLTs. We studied 25 children with HUS, 63 children with SLT-positive bloody diarrhea, 62 children with bloody diarrhea not associated with SLTs and 39 children admitted for elective surgery, included as an age- and season-matched control group. The TNF-alpha concentrations were found to be significantly elevated in children with HUS (range, 1 to 95 pg/ml; geometric mean, 32.2 pg/ml) compared with the healthy controls (range, 0 to 53 pg/ml; mean, 12.5 pg/ml; P < 0.001). Because it is hypothesized that TNF-alpha elevation might precede development of HUS, we also studied children with blood diarrhea. The TNF-alpha serum concentrations were significantly higher during the first 10 days after onset of bloody diarrhea than after the first 10 days (P < 0.02). Such elevation could be associated with vascular endothelial glycolipid receptor up-regulation and increased susceptibility to the effects of SLTs.
溶血尿毒综合征（HUS）被认为是一种血管内皮损伤性疾病。尽管已知细胞毒素（志贺样毒素（SLTs））与之相关，但其损伤机制尚不清楚。最近的证据表明，用肿瘤坏死因子α（TNF-α）对某些内皮细胞进行体外处理会显著增加它们对SLTs的敏感性。我们研究了25例HUS患儿、63例SLT阳性血性腹泻患儿、62例与SLTs无关的血性腹泻患儿以及39例因择期手术入院的患儿，后者作为年龄和季节匹配的对照组。结果发现，与健康对照组（范围为0至53 pg/ml；平均值为12.5 pg/ml；P < 0.001）相比，HUS患儿的TNF-α浓度显著升高（范围为1至95 pg/ml；几何平均值为32.2 pg/ml）。由于推测TNF-α升高可能先于HUS的发生，我们还研究了血性腹泻患儿。血性腹泻发作后头10天内的TNF-α血清浓度显著高于发作10天后（P < 0.02）。这种升高可能与血管内皮糖脂受体上调以及对SLTs作用的敏感性增加有关。
