| Objective:Chemotherapy is one of the main treatments of malignant tumors in pediatric hematology-oncology patients, but it may also damage the immune system of the body, leading to neutropenia. Infection is one of the most common complications after chemotherapy and the most important cause of death in these children. So early diagnosis of infection and appropriate choice of antibiotics are important to improve the prognosis of the patients. Presently, the most commonly used diagnostic methods for infections include the blood test, C reactive protein(CRP). procalcitonin(PCT). the blood culture and so on. But these methods do not have high sensitivity or specificity for early diagnosis of infection in these patients. Recently, attention has been paid to the role of cytokines. Many studies have showed the close association between cytokines and infection. But the studies on the distinguishing between the gram-positive and negative bacterial infections through the cytokine profiles are very rare. The aim of this study is to investigate the Thl/Th2 cytokines in G+/G- sepsis in pediatric hematology-oncology patients and to seek for a rapid diagnostic method to determine the type of infection in G+/G-sepsis.Methods:The concentrations of Thl/Th2 cytokines from 190 hospitalized hematology-oncology children with positive blood culture from January 2008 through May 2010 were determined by flow cytometry bead assay (CBA) at the time of fever within 24 hours. The concentrations of these cytokines from 69 patients above-mentioned were determined within 24 hours after fever subsided.99 hospitalized hematology-oncology children without any evidence of infection were enrolled as control. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software, version 17.0. Serum concentrations of individual cytokines were compared between the febrile group and the control group, gram-positive and gram-negative bacterial infections group, using Mann-Whitney U test. Serum concentrations of individual cytokines were compared between fever(Tl) and fever subsided(T2) using Wilcoxon rank test. The correlations among IL-2, IL-4, IL-6, IL-10, TNF-a and IFN-y were analyzed using the Spearman Correlation analysis. The study was to analyze the cytokine profiles in G+/G-sepsis in pediatric hematology-oncology patients and to explore the rule of bacterial infection related cytokine profile (BIRCP). A two-sided P-value of<0.05 was considered to be statistically significant.Results:IL-2, IL-4, IL-6, IL-10, TNF-a and IFN-y levels from sepsis groups were significantly higher than those from controls at the time of fever (P< 0.01).The median levels of IL-6, IL-10, TNF-a of group G-were 284.35pg/ml,98.70pg/ml,4.45pg/ml. respectively, significantly higher than those of group G+(72.15pg/ml,10.90pg/ml, 2.85pg/ml, respectively, P< 0.01)。According to the different degrees of increased IL-6 and IL-10 levels, we named the G- bacteria infection related cytokine profile G-BIRCP and the G+ BIRCP. The specificity and sensitivity of BIRCP prediction for G-and G+ bacteria cultures were 83.70% and 60.20%.60.20% and 83.70%. respectively. The median levels of IL-6, IL-10, TNF-α, IFN-γfrom sepsis groups at the time of fever(T1) were 9.30pg/ml,5.90pg/ml,2.4pg/ml,4.8pg/ml, respectively, significantly lower than those after fever subsided(T2)(212.2pg/ml,99.6pg/ml,3.0pg/ml,6.90pg/ml, respectively, P<0.01)Conclusions:These results showed the levels of IL-2, IL-4, IL-6, IL-10, TNF-αand IFN-γrose in sepsis in pediatric hematology-oncology patients. The levels of IL-6, IL-10, TNF-αwere higher in pediatric hematology-oncology patients with G-sepsis than in those with G+ sepsis. The IL-6 and IL-10 determination with CB A technology can be used for the early and rapid diagnosis and evaluation of G+/G- sepsis in pediatric hematology-oncology patients. The levels of IL-6, IL-10, TNF-αand IFN-γin pediatric hematology-oncology patients with sepsis began to decrease within 24 hours after fever subsides. |
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