Am J Resp Crit Care:重症脓毒症患儿早期免疫功能及器官功能的相关性分析!

2018-03-01 xing.T MedSci原创

由此可见,严重脓毒症或脓毒性休克患儿表现出早期先天免疫和适应性免疫抑制。先天性和适应性免疫的早期抑制与器官功能障碍的持续时间有关,可能是指导脓毒症儿童免疫调节治疗的有用指标。

晚期免疫抑制与脓毒症成人和儿童医院感染以及死亡率相关。脓毒症儿童早期免疫抑制与预后之间的关系尚不清楚。近日,呼吸内科以及重症医学领域权威杂志Am J Resp Crit Care上发表了一篇研究文章,该前瞻性观察性研究旨在验证早期先天性免疫和适应性免疫抑制与严重脓毒症/脓毒性休克患儿器官功能障碍持续时间之间存在相关性的假设。

研究人员对小于18岁满足严重脓毒症或感染性休克共识标准的儿童收集脓毒症发病48小时内的血液样本。健康对照者取样一次。研究人员采用全血体外脂多糖诱导肿瘤坏死因子α产生能力来定量评估先天性免疫功能。适应性免疫功能是通过体外植物血凝素诱导的IFNγ生产能力来评估。

102名脓毒症儿童和35名健康儿童入选研究。与健康儿童相比,脓毒症患儿LPS诱导的肿瘤坏死因子α生成减少(P<0.0001),PHA诱导的γ干扰素产生降低(P<0.0001)。在脓毒症儿童中,早期先天免疫和适应性免疫抑制与更长的多器官功能障碍(MODS)和器官功能障碍天数有关。在多变量分析中,早期先天性免疫抑制仍然与增加的MODS [aRR为1.2(1.03-1.5)]和器官功能障碍[aRR为1.2(1.1-1.3)] 独立相关。

由此可见,严重脓毒症或脓毒性休克患儿表现出早期先天免疫和适应性免疫抑制。先天性和适应性免疫的早期抑制与器官功能障碍的持续时间有关,可能是指导脓毒症儿童免疫调节治疗的有用指标。

原始出处:


Jennifer A Muszynski,et al. Early Immune Function and Duration of Organ Dysfunction in Critically Ill Septic Children.AM J RESP CRIT CARE 2018. https://doi.org/10.1164/rccm.201710-2006OC         

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