白细胞减少大鼠革兰氏阴性和革兰氏阳性感染的鉴别诊断开始发热时循环炎症介质。

Eva Tavares, Rosario Maldonado, Maria L Ojeda, Francisco J Miñano
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引用次数: 46

摘要

革兰氏阴性和革兰氏阳性感染被认为是化疗后白细胞减少患者发病和死亡的最重要原因。然而,区分细菌感染和无害发热发作是困难的。由于感染的典型炎症体征通常不存在,发烧通常是感染的唯一体征,本研究的目的是评估血清白细胞介素-6 (IL-6)、IL-10、巨噬细胞炎症蛋白-2 (MIP-2)、降钙素原(PCT)、和c反应蛋白(CRP)模式识别细菌感染在正常和环磷酰胺处理(白细胞减少)大鼠开始发烧期间注射脂多糖(LPS)或muramyl二肽(MDP)作为革兰氏阴性和革兰氏阳性细菌感染的模型。我们发现,与正常大鼠相比,免疫抑制动物在毒素攻击后表现出明显更高的发烧和更少的所有介质的产生,除了IL-6。此外,与接受MDP的大鼠相比,接受等量LPS的两组动物都表现出明显更高的发烧和更大的血清细胞因子水平增加。此外,与免疫正常大鼠相比,注射MDP后白细胞减少动物血清IL-6和MIP-2水平无明显变化。其他血清标记物如PCT和CRP不能区分两组动物的细菌刺激。这些结果表明,在发热早期使用分析的血清标志物可以为临床医生提供有用的信息,以排除革兰氏阴性感染和革兰氏阳性感染。
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Circulating inflammatory mediators during start of fever in differential diagnosis of gram-negative and gram-positive infections in leukopenic rats.

Gram-negative and gram-positive infections have been considered the most important causes of morbidity and mortality in patients with leukopenia following chemotherapy. However, discrimination between bacterial infections and harmless fever episodes is difficult. Because classical inflammatory signs of infection are often absent and fever is frequently the only sign of infection, the aim of this study was to assess the significance of serum interleukin-6 (IL-6), IL-10, macrophage inflammatory protein-2 (MIP-2), procalcitonin (PCT), and C-reactive protein (CRP) patterns in identifying bacterial infections during start of fever in normal and cyclophosphamide-treated (leukopenic) rats following an injection of lipopolysaccharide (LPS) or muramyl dipeptide (MDP) as a model for gram-negative and gram-positive bacterial infections. We found that, compared to normal rats, immunosuppressed animals exhibited significantly higher fevers and lesser production of all mediators, except IL-6, after toxin challenge. Moreover, compared to rats that received MDP, both groups of animals that received an equivalent dose of LPS showed significantly higher fevers and greater increase in serum cytokine levels. Furthermore, in contrast to those in immunocompetent rats, serum levels of IL-6 and MIP-2 were not significantly changed in leukopenic animals after MDP injection. Other serum markers such as PCT and CRP failed to discriminate between bacterial stimuli in both groups of animals. These results suggest that the use of the analyzed serum markers at an early stage of fever could give useful information for the clinician for excluding gram-negative from gram-positive infections.

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