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Plasma cytokine profiles in very preterm infants with late-onset sepsis.

晚发性脓毒症极早产儿血浆细胞因子谱.

  • 影响因子:3.02
  • DOI:10.1371/journal.pone.0232933
  • 作者列表:"Hibbert J","Strunk T","Simmer K","Richmond P","Burgner D","Currie A
  • 发表时间:2020-05-14
Abstract

INTRODUCTION:Deficiencies in innate immune responses may contribute to the increased susceptibility to infection in preterm infants. In vivo cytokine profiles in response to sepsis in very preterm infants are not fully understood. AIMS:To characterise plasma pro- and anti-inflammatory cytokine concentrations and pre-defined ratios in very preterm infants with late-onset sepsis (LOS). METHODS:In this observational study, peripheral blood samples were collected at the time of evaluation for suspected LOS from 31 preterm infants (<30 weeks gestational age). Plasma cytokine concentrations were determined by 12-plex immunoassay. RESULTS:IL-10, IFN-γ, IL-12p70, IP-10, IL-6 and CCL2 were elevated in the majority infants with LOS (n = 12) compared to those without LOS (n = 19). There was no difference in TNF-α, IL-1β, IL-17AF, IL-8 and IL-15 concentrations between groups. IL-10/TNF-α ratios were increased, while CCL2/IL-10 and IL-12p70/IL-10 ratios were decreased in infants with LOS compared to those without. CONCLUSION:Very preterm infants have a marked innate inflammatory response at the time of LOS. The increase in IL-10/TNF-α ratio may indicate early immune hypo-responsiveness. Longitudinal studies with a larger number of participants are required to understand immune responses and clinical outcomes following LOS in preterm infants.

摘要

引言: 先天免疫反应的缺陷可能导致早产儿感染易感性增加。在非常早产的婴儿中,响应于脓毒症的体内细胞因子谱尚未完全了解。 目的: 表征患有晚发性脓毒症 (LOS) 的极早产儿的血浆促炎细胞因子和抗炎细胞因子浓度以及预定义的比率。 方法: 在这项观察性研究中,在评估31例早产儿 (胎龄 <30周) 疑似LOS时收集外周血样本。通过12-复合物免疫测定法测定血浆细胞因子浓度。 结果: IL-10,IFN-γ,IL-12p70,IP-10,IL-6和CCL2在大多数患有LOS的婴儿 (n = 12) 中高于没有LOS的婴儿 (n = 19)。组间TNF-α 、IL-1β 、IL-17AF、IL-8和IL-15浓度无差异。与未患LOS的婴儿相比,患LOS的婴儿的IL-10/TNF-α 比率增加,而CCL2/IL-10和IL-12p70/IL-10比率降低。 结论: 极早产儿在LOS时具有明显的先天性炎症反应。IL-10/TNF-α 比值的增加可能表明早期免疫低反应性。需要有更多参与者的纵向研究来了解早产儿LOS后的免疫反应和临床结局。

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METHODS::Background: Early onset sepsis (EOS) is potentially life-threatening problem especially in preterm. EOS diagnosis is challenging due to its non-specific signs and laboratory tests. Mean platelet volume (MPV) has been used as predictor of many inflammatory diseases.Objectives: To assess the correlation between serial MPV measurement and EOS occurrence in preterm infants and to determine MPV effectiveness in combination with C reactive protein (CRP) to diagnose EOS and mortality prediction.Methods: The study was carried out on 95 preterm infants with antenatal risk factor for EOS. Blood samples were taken for complete blood count (CBC) including MPV evaluated at birth (cord blood) and at 72 h of life. CRP analyzed on days 1 and 3, subsequently patients were identified in two groups: sepsis (n = 28) and no-sepsis (n = 67).Results: MPV was significantly higher on both day 1 (10.23 ± 0.92) fl and day 3 (10.77 ± 1.16) fL in the sepsis group compared with no-sepsis (8.11 ± 0.29) fl and (8.53 ± 0.42) fl, respectively. MPV of 8.6 fL was identified as cut off value in patients probably resulting in sepsis with a sensitivity of 97.14% and a specificity of 100%. MPV of 10.4 fl was determined as cut off value in patients possibly resulting in death with a sensitivity of 70% and a specificity of 82.5%. The combination of both MPV and CRP on day 1 resulted in improving performance of MPV with higher negative predictive value (93.1%) and higher sensitivity (80%).Conclusion: High cord blood and day 3 MPV can be used as surrogate marker for prediction of EOS and associated mortality in preterm neonates.

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METHODS::Objective: This study used near-infrared spectroscopy (NIRS) to detect the pulmonary regional oxygen saturation (rSO2) of premature infants. The oxygenation state of the lung tissue was also evaluated, which provided preliminary evidence regarding the application of NIRS in oxygen therapy for premature infants.Methods: NIRS was used to measure the pulmonary rSO2 of 26 premature infants (gestational age <32 weeks). The correlations between pulmonary rSO2 and the arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), and pulse oxygen saturation (SpO2) were analyzed. The diagnostic value of NIRS was evaluated via both Pearson's correlation and receiver operating characteristic (ROC) curve analyses.Results: Pulmonary rSO2 was positively correlated with both PO2 and SaO2; the linear correlation coefficients (r) were 0.544 (p = .004) and 0.515 (p = .007), respectively. No significant correlation was found between rSO2 and SpO2 (p = .098). SpO2 was positively correlated with PO2 (r = 0.402, p = .042) and SaO2 (r = 0.625, p = .001). NIRS could be used to predict hypoxemia (area under the curve [AUC] = 0.843; Youden's index =0.654) when the pulmonary rSO2 was 62.39%, the sensitivity was 88.9%, and the specificity was 23.5% (p = .005) as well as predict hyperoxemia (AUC = 0.775; Youden's index = 0.65) when the pulmonary rSO2 was 61.99%, the sensitivity was 100%, and the specificity was 35% (p = .045). SpO2 predicted hypoxemia (AUC = 0.784, p = .019) but not hyperoxemia (AUC = 0.7, p = .144).Conclusion: NIRS objectively reflects the changes in oxygenation in the lung tissue. This study provides evidence for the clinical application of NIRS.

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新生儿/早产方向

新生儿指的是胎儿娩出母体并自脐带结扎起,至出生后满28天这一段时间的婴儿;早产儿是指胎龄在37足周以前出生的活产婴儿称为早产儿或未成熟儿。

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