摘要
目的检测不同免疫状态脓毒症婴幼儿细胞因子浓度的变化，探讨婴幼儿脓毒症免疫功能紊乱的可能机制。方法深圳市儿童医院重症监护室2007年5月至11月收治的脓毒症患儿36例为研究组，16例正常婴幼儿为对照组。根据人类白细胞抗原（HLA）-DR的测定值，将患儿分为免疫激活组（DR—H组）和免疫抑制组（DR-L组）。用流式细胞术检测CD14^＋单核细胞HLA-DR表达率；实时荧光定量PCR检测CD4^＋T细胞IL-10、IL-6mRNA表达；ELISA检测IL-1β、IL-6、TNF-α、IL-10血浆浓度。结果（1）小儿危重病例评分DR-H组高于DR—L组（90．15±4．43VS81．91±7．45，P〈0．05）。（2）细胞因子变化：两组前炎症细胞因子IL-1β、IL-6血浓度均明显高于对照组（P〈0．05），DR—H组TNF-α高于对照组。两组间比较，IL-1β及IL-6差异无显著性，DR-H组TNF-α高于DR—L组（P〈0．05）。两组IL-6基因表达均高于对照组（P〈0．05），以DR-L组增高尤为显著。两组IL-10均高于对照组（P〈0．05），DR—L组IL-10基因表达高于对照组及DR—H组。结论CD14^＋单核细胞HLA-DR表达检测对婴幼儿脓毒症危重程度及预后有一定判断价值。婴幼儿脓毒症发病过程中，前炎症细胞因子始终处于高表达状态，导致免疫抑制的主要原因可能是抗炎因子IL-10过表达。
Objective To investigate the changes of cytokines in infants with immunological activated or immunosuppressed status of sepsis. Methods Thirty-six infants with sepsis and 16 age-matched healthy infants were enrolled from May to November in 2007. Thirty-six infants were divided into two groups according to the levels of HLA-DR expression ： DR-H group （ HLA-DR expression 〉 30% ） and DR-L group （ HLA-DR expression 〈 30% ）. CD14^＋ monocyte HLA-DR expression was analyzed by flow cytometry. Cytokine（ IL-1β, IL-6, TNF-α, IL-10 ）were measured by enzyme-linked immunosorbent assay. Real-time PCR were used to evaluate the mRNA levels of IL-6 and IL-10 in CD4^＋ T cells. Results （ 1 ） Pediatric critical illness score in DR-H group was higher than that in DR-L group （ P 〈 0. 05 ）. （ 2 ） Serum concentrations of pro-inflammatory cytokine（IL-1β,IL-6） elevated significantly in DR-H group and DR-L group（ P 〈 0. 05 ）. Serum concentrations of TNF-α elevated significantly in DR-H group. There was no significant difference of IL-1β and IL-6 between DR-H and DR-L group, while protein level of TNF-α in DR-H group was higher than that in DR-L group（ P 〈 0. 05 ）. Transcription level of IL-6 mRAN was significantly up-regulated in DR- H group and DR-L group（ P 〈 0.05 ） ,especially in DR-L group in which IL-6 level was higher than that in DR-H group. The protein level of ant-inflammatory cytokine （IL-10）increased significantly in DR-H group and DR-L group（ P 〈 0. 05 ）, the mRNA level of IL-10 raised significantly in DR-L group （ P 〈 0. 05 ）, while mRNA and protein levels of IL-10 in DR-L group were higher than those in DR-H group（P 〈0. 05）. Conclusion HLA-DR expression of monocytes cells could be a valuable index to judge the critical level of pediattic illness and serve as an index to predict outcome of infant with sepsis. Over-expression of pro-inflammatory cytokine was found along with all the phage of sepsis. High expression of IL-10 may be contributed to immune suppression in infant with sepsis.
出处
《中国小儿急救医学》
CAS
2009年第5期438-440,共3页
Chinese Pediatric Emergency Medicine
作者简介
通信作者：李成荣，E-mail：rogasan@gmail．com
