| PrefaceSIRS is the systemic inflammatory response to a variety insults, independent of its causes. It is induced by uncontrolled release of inflammatory mediators , these mediators interact with each other, and form a cytokine cascades network , result in tissue and organ injuries. Once the inflammatory response is initiated, it would continue and enlarge, regarding of its cause, MODS or even MOF would develop. Many studies have showed that cytokines in patients with SIRS increase significantly, high level of cytokines imply poor prognosis. Detecting and diagnosis of SIRS in early stage is significant to interrupt the pathophys-iologic process.Up to now, less researches were reported on less severe SIRS patients. We chose less severe SIRS patients according to pediatric severity score, and determined their plasma level of IL-1,IL-6 IL-8 TNF-, and analyzed the changes of the cytokines in these patients.Patients and Methods1. PatientsThe study was conduced from January to December 2001 in Guangzhou Children' s Hospital. We prospectively studied 43 SIRS patients with the score of severity less than 80, ageing from 1 month to 11 years old. Among them, 24 were boys and 19 girls.Meanwhile, we chose 48 healthy children as control group.2. DiagnosesSIRS was defined using a modification of the guidelines developed by Hay-den in 1996. (1) temperature >38 C or <36 C; (2) heart rate higher than 2SD upon normal for age; (3) respiratory rate higher than 2SD upon normal forage orPaC02 < 32mmHg ; (4) WBC count > 12000/mm3or <4000/mm3 or 10% immature forms on the peripheral blood smear. When two or more of these manifestations manifests the patient, SIRS can be diagnosed.A severity score was calculated according to pediatric severity score criteria proposed in 1995 and modified in 1996.3. Blood Collection and Laboratory ProcessingBlood samples of SIRS patients and normal controls, 3ml blood each person , were collected within 24 hours after admission or on normal physical examination respectively. Blood samples were centrifuged at 1500g for 5min, and plasma was aspirated and stored at -70t.The plasma was warmed in the lab, the levels of IL-lpxIL-6^IL-8xTNF-a were determined.4. Statistical AnalysisData were expressed as means SD. T test or x2 test were applied to compare the difference between two groups. Statistical significance was considered at the 5% level.Results1. IL-1 could not be detected in all of the 43 patients and 43 healthy children.2. IL-6 could be detected in 18 patients of 43 SIRS patients and 2 among 37 healthy children. Significant difference was found between two groups, P < 0.01.3. IL-8 could be detected in 21 out of 43 patients and in 17 out of 37 healthy children. There was no significant difference between two groups, P >0. 05.4. Compared TNF- levels in the patients and healthy children with t test, there was no significant difference between them, p >0.05.DiscussionThere are three hypotheses about SIRS as following: cytokines hypothesis, positive feedback hypothesis and immunologic dissonance hypothesis. The same opinion of these hypotheses is that inflammatory mediators release uncontrollably ; the mediators interact and induce with each other, and form a complex cascade network, then tissues or organ injury develops. TNF- , IL-1 , IL-6 and IL-8 are proinflammatory cytokines among them. TNF is considered to be primary mediator, which initiates the systemic inflammatory response and induces the release of other cytokines, its level is related to the severity of disease. IL-1 pis also produced quiet earlier, it cooperate with TNF-. IL-6 release under the stimulation of TNF- and IL-1 , in general, its release is later than TNF-a and IL-1 .Many studies have been performed on proinflammoty cytokines in SIRS. Many of them showed that TNF-, increase in the early stage of SIRS, its level is related to the severity. The level of IL-1 is quiet different in patients with SIRS, the trials by Wangtao and Huxiaomin suggested t... |
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