Doughty L A, Kaplan S S, Carcillo J A
Department of Anesthesiology/Critical Care Medicine, University of Pittsburgh, PA, USA.
Crit Care Med. 1996 Jul;24(7):1137-43. doi: 10.1097/00003246-199607000-00012.
To examine the relationship of circulating proinflammatory and anti-inflammatory cytokine concentrations to nitric oxide and organ failure in pediatric sepsis.
Prospective study.
Pediatric intensive care unit (ICU), children's Hospital of Pittsburgh, University of Pittsburgh.
Nineteen patients with a diagnosis of sepsis admitted to the pediatric ICU. Twelve uninfected critically iII patients served as controls.
None.
Plasma interleukin (IL)-10, IL-6, and nitrite/nitrate concentrations were measured and compared with an index of organ failure daily for 3 days after presentation with the sepsis syndrome. Children with increased plasma IL-6 concentrations (n = 6) had increased plasma nitrite/nitrate concentrations (p < 0.01 on each day), increased organ failure scores (p < .05 on days 1 and 3), and the highest plasma IL-10 concentrations (p < .05 on days 1 and 3, p = .054 on day 2) when compared with children with sepsis and undetectable IL-6 concentrations. Children with sepsis and detectable IL-6 concentrations, and children with undetectable IL-6 concentrations, both had increased nitrite/nitrate concentrations (p < .005 on days 1 through 3) and increased IL-10 concentrations (p < .05 on days 1 and 2) compared with controls. Children with increased IL-6 concentrations had higher organ failure on each day (p < .01), and children with undetectable IL-6 concentrations had higher organ failure on days 1 and 2 only (p < .005) when compared with controls. Organ failure improved over time in the children with undetectable IL-6 concentrations (p < .005).
Increased plasma nitrite/nitrates and increased organ failure scores occurred in the children with sepsis who had an exaggerated proinflammatory state, despite a pronounced anti-inflammatory response. When the anti-inflammatory response predominated and the proinflammatory state was dampened, organ failure status improved.
研究小儿脓毒症患者循环中促炎和抗炎细胞因子浓度与一氧化氮及器官功能衰竭之间的关系。
前瞻性研究。
匹兹堡大学匹兹堡儿童医院小儿重症监护病房（ICU）。
19例诊断为脓毒症的患儿入住小儿ICU。12例未感染的重症患儿作为对照。
无。
在出现脓毒症综合征后的3天内，每天测量血浆白细胞介素（IL）-10、IL-6以及亚硝酸盐/硝酸盐浓度，并与器官功能衰竭指标进行比较。与脓毒症且IL-6浓度检测不到的患儿相比，血浆IL-6浓度升高的患儿（n = 6）血浆亚硝酸盐/硝酸盐浓度升高（每天p < 0.01）、器官功能衰竭评分增加（第1天和第3天p < 0.05），且血浆IL-10浓度最高（第1天和第3天p < 0.05，第2天p = 0.054）。与对照组相比，脓毒症且IL-6浓度可检测到的患儿以及IL-6浓度检测不到的患儿，亚硝酸盐/硝酸盐浓度均升高（第1天至第3天p < 0.005），IL-10浓度也升高（第1天和第2天p < 0.05）。与对照组相比，IL-6浓度升高的患儿每天器官功能衰竭程度更高（p < 0.01），IL-6浓度检测不到的患儿仅在第1天和第2天器官功能衰竭程度更高（p < 0.005）。IL-6浓度检测不到的患儿器官功能衰竭随时间改善（p < 0.005）。
脓毒症患儿即使存在明显的抗炎反应，但如果促炎状态过度，血浆亚硝酸盐/硝酸盐浓度会升高，器官功能衰竭评分也会增加。当抗炎反应占主导且促炎状态受到抑制时，器官功能衰竭状态会改善。
