Ishikawa K, Tanaka H, Matsuoka T, Shimazu T, Yoshioka T, Sugimoto H
Department of Traumatology, Osaka University Medical School, Japan.
J Trauma. 1998 Jun;44(6):1047-54; discussion 1054-5. doi: 10.1097/00005373-199806000-00018.
The objective of this study was to determine the effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) administration in septic patients with neutropenia.
Twenty consecutive septic patients were administered rhG-CSF subcutaneously (2 microg x kg(-1) x d(-1)) for 5 days (group G). They were compared with 14 septic patients treated earlier without rhG-CSF (group N). All patients in both groups met the criteria of total leukocyte count (TLC) less than 5,000/mm3 and C-reactive protein (CRP) more than 10 mg/dL. Changes in TLC, absolute neutrophil count (ANC), CRP, respiratory index (RI), Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Goris's Multiple Organ Failure (MOF) index were evaluated. In addition, nucleated cell count (NCC), differentiation in bone marrow aspiration, neutrophil phagocytic and bactericidal activity, serum concentrations of interleukin-6 (IL-6) and IL-8 as inflammatory markers, and plasma concentration of leukocyte elastase (LE) as an indicator of the tissue injury were evaluated in group G.
In group G, TLC, ANC, NCC, and neutrophil functions increased significantly, whereas CRP, IL-6, and IL-8 decreased reciprocally. There was no deterioration of LE and RI. Consequently, the APACHE II score and MOF index improved. In group N, however, CRP showed no change concomitant with the APACHE II score and MOF index.
Administration of rhG-CSF attenuates inflammatory responses without inducing tissue injury in septic patients with neutropenia.
本研究旨在确定重组人粒细胞集落刺激因子（rhG-CSF）对脓毒症伴中性粒细胞减少患者的影响。
连续20例脓毒症患者皮下注射rhG-CSF（2微克×千克⁻¹×天⁻¹），共5天（G组）。将他们与14例早期未接受rhG-CSF治疗的脓毒症患者（N组）进行比较。两组所有患者均符合白细胞总数（TLC）低于5000/mm³和C反应蛋白（CRP）高于10mg/dL的标准。评估TLC、绝对中性粒细胞计数（ANC）、CRP、呼吸指数（RI）、急性生理与慢性健康状况评分系统（APACHE）Ⅱ评分以及戈里斯多器官功能衰竭（MOF）指数的变化。此外，对G组患者还评估了有核细胞计数（NCC）、骨髓穿刺中的分化情况、中性粒细胞吞噬和杀菌活性、作为炎症标志物的白细胞介素-6（IL-6）和IL-8的血清浓度，以及作为组织损伤指标的白细胞弹性蛋白酶（LE）的血浆浓度。
G组中，TLC、ANC、NCC和中性粒细胞功能显著增加，而CRP、IL-6和IL-8则相应降低。LE和RI没有恶化。因此，APACHEⅡ评分和MOF指数有所改善。然而，在N组中，CRP没有变化，同时APACHEⅡ评分和MOF指数也未改变。
在脓毒症伴中性粒细胞减少的患者中，给予rhG-CSF可减轻炎症反应而不引起组织损伤。
