Austgulen R, Arntzen K J, Haereid P E, Aag S, Døllner H
Norwegian University of Science and Technology, Institute of Cancer Research and Molecular Biology, Trondheim, Norway.
Acta Paediatr. 1997 Mar;86(3):274-80. doi: 10.1111/j.1651-2227.1997.tb08889.x.
All newborn infants consecutively admitted to the Neonatal Intensive Care Unit (NICU) at the University Hospital of Trondheim during 1993 were eligible to participate in the study. In total, 241 neonates were included, for whom anamnestic, clinical and laboratory characteristics were recorded. Peripheral blood was retrieved at admittance, and serum levels of soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin were determined. Newborn infants were classified as infected or non-infected according to selected criteria, and 24 newborn infants fulfilled the criteria of having an infection, whereas 168 newborn infants were classified as non-infected. ICAM-1, VCAM-1 and E-selectin were detected in all neonatal samples. Serum concentrations of E-selectin varied by gestational age (GA), higher levels were found in non-infected term (GA > or = 37 weeks) neonates (n = 53) than in those (n = 115) delivered prematurely (GA < 37 weeks) without infection (p < 0.0001), whereas ICAM-1 and VCAM-1 concentrations did not differ between groups of non-infected term and preterm newborn infants. Similarly, newborn infants delivered at term (n = 16) demonstrated higher levels of E-selectin than premature infants (n = 8) in association with infection (p < 0.001). Both ICAM-1 and E-selectin were increased in term newborn infants with infection (n = 16) compared to the non-infected term group (n = 53) (both p < 0.01), whereas VCAM-1 concentrations did not differ between the two groups. In the premature groups of infected (n = 8) and non-infected (n = 115) neonates, no differences in ICAM-1, VCAM-1 and E-selectin concentrations were observed. The use of ICAM-1 concentration (cut-off level: 250 micrograms l-1) as a diagnostic test for infection in term neonates yielded a sensitivity of 80% and a specificity of 61%, whereas a sensitivity of 70% and a specificity of 79% were found when E-selectin concentration (cut-off level: 150 micrograms l-1) was used. Conclusively, increased shedding of soluble ICAM-1 and E-selectin is one component of infection-induced neonatal immune response after full-time pregnancies. Our data suggest that the ability of increased shedding of soluble ICAM-1 and E-selectin molecules is developed during the final weeks of pregnancy. Assessment of ICAM-1 and E-selectin concentrations may be used as diagnostic tools with a high sensitivity and a moderate specificity in term neonates suspected of infection.
1993年期间，所有连续入住特隆赫姆大学医院新生儿重症监护病房（NICU）的新生儿均有资格参与该研究。总共纳入了241名新生儿，记录了他们的既往史、临床和实验室特征。入院时采集外周血，测定血清可溶性细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）和E-选择素水平。根据选定标准将新生儿分为感染组或非感染组，24名新生儿符合感染标准，而168名新生儿被分类为非感染组。所有新生儿样本中均检测到ICAM-1、VCAM-1和E-选择素。E-选择素的血清浓度因胎龄（GA）而异，未感染的足月儿（GA≥37周）（n = 53）中E-选择素水平高于未感染的早产儿（GA＜37周）（n = 115）（p＜0.0001），而未感染的足月儿和早产儿组之间ICAM-1和VCAM-1浓度无差异。同样，足月分娩的新生儿（n = 16）在感染时E-选择素水平高于早产儿（n = 8）（p＜0.001）。与未感染的足月儿组（n = 53）相比，感染的足月儿（n = 16）中ICAM-1和E-选择素均升高（均p＜0.01），而两组之间VCAM-1浓度无差异。在感染的早产儿组（n = 8）和未感染的早产儿组（n = 115）中，未观察到ICAM-1、VCAM-1和E-选择素浓度的差异。使用ICAM-1浓度（临界值：250微克/升）作为足月儿感染的诊断测试，敏感性为80%，特异性为61%，而使用E-选择素浓度（临界值：150微克/升）时，敏感性为70%，特异性为79%。总之，可溶性ICAM-1和E-选择素释放增加是足月妊娠后感染诱导的新生儿免疫反应的一个组成部分。我们的数据表明，可溶性ICAM-1和E-选择素分子释放增加的能力在妊娠最后几周形成。对怀疑感染的足月儿，评估ICAM-1和E-选择素浓度可作为具有高敏感性和中等特异性的诊断工具。
