Harris M C, Costarino A T, Sullivan J S, Dulkerian S, McCawley L, Corcoran L, Butler S, Kilpatrick L
Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19104.
J Pediatr. 1994 Jan;124(1):105-11. doi: 10.1016/s0022-3476(94)70264-0.
We hypothesized that plasma levels of cytokines such as interleukin-6 and tumor necrosis factor (TNF) are elevated in critically ill infants with sepsis and necrotizing enterocolitis (NEC) and that the magnitude of their elevation is correlated with mortality rate. We measured plasma levels of interleukin-6 and TNF in 62 newborn infants with suspected sepsis or NEC. Eighteen infants had bacterial sepsis, 9 had bacterial sepsis plus NEC, and 15 had NEC but negative culture results. Twenty comparably ill infants with negative results on culture of systemic specimens served as study control subjects. Interleukin-6 levels were five- to tenfold higher in infants with bacterial sepsis plus NEC at the onset of disease than in infants with bacterial sepsis alone, in infants with NEC but negative culture results, and in control infants (p < 0.01). These differences persisted throughout the 48-hour study period. Interleukin-6 levels were also significantly higher in nonsurvivors than in survivors (p < 0.001). In contrast, plasma TNF values were not consistently increased in any of the groups. We conclude that plasma interleukin-6 is a more reliable indicator of bacterial sepsis and NEC than plasma TNF and may identify infants who might benefit from immunotherapeutic strategies.
我们推测，脓毒症和坏死性小肠结肠炎（NEC）重症婴儿的血浆细胞因子水平，如白细胞介素-6和肿瘤坏死因子（TNF）会升高，且其升高幅度与死亡率相关。我们检测了62例疑似脓毒症或NEC的新生儿的血浆白细胞介素-6和TNF水平。18例婴儿患有细菌性脓毒症，9例患有细菌性脓毒症加NEC，15例患有NEC但培养结果为阴性。20例全身标本培养结果为阴性的病情相当的婴儿作为研究对照对象。在疾病发作时，患有细菌性脓毒症加NEC的婴儿的白细胞介素-6水平比仅患有细菌性脓毒症的婴儿、患有NEC但培养结果为阴性的婴儿以及对照婴儿高5至10倍（p < 0.01）。这些差异在整个48小时的研究期间持续存在。非存活者的白细胞介素-6水平也显著高于存活者（p < 0.001）。相比之下，任何一组的血浆TNF值都没有持续升高。我们得出结论，与血浆TNF相比，血浆白细胞介素-6是细菌性脓毒症和NEC更可靠的指标，并且可能识别出可能从免疫治疗策略中受益的婴儿。
