Mediadores pró-inflamatórios e antinflamatórios na sepse neonatal: associação entre homeostase e evolução clínica

Autores

  • Marco Antonio Cianciarullo Universidade de São Paulo; Hospital Universitário; Berçário
  • Maria Esther Jurfest Ceccon Hospital Estadual de Sapopemba; Berçário
  • Lidia Yamamoto LIM 36
  • Gilda Maria Barbaro Del Negro LIM 36
  • Thelma Suely Okay Universidade de São Paulo; Faculdade de Medicina; Departamento de Pediatria

DOI:

https://doi.org/10.7322/jhgd.19875

Palavras-chave:

Recém-nascido, Sepse, Mediadores pró-inflamatórios (TNF-±, IL-², IL-6), Mediadores antinflamatórios (IL-10 e IL-1Ra), Relação IL-6/IL-1Ra

Resumo

OBJETIVO: avaliar a utilidade de citocinas pró-inflamatórias (TNF-±, IL-1² e IL-6) e de citocinas antinflamatórias (IL-10 e IL-1Ra) no diagnóstico da sepse neonatal, e verificar se a homeostase entre estes mediadores poderia ser determinante para a evolução clínica da doença. MÉTODO: coorte prospectiva compreendendo 31 recém-nascidos (RN) com diagnóstico de sepse neonatal, classificados em dois grupos: sepse e sepse grave, com evolução complicada (choque, falência múltipla de órgãos, óbito). Os níveis séricos de TNF-±; IL-1²; IL-6; IL-10 e IL-1Ra foram mensurados nos dias 0 (diagnóstico), 3 e 7 (evolutivos). Foram calculadas as médias, desvios-padrão, medianas, e valores mínimos e máximos para cada um dos mediadores. Foram construídos gráficos dos perfis individuais dos pacientes, e o perfil médio dos dois grupos contendo os erros-padrão. Para o tratamento estatístico dos dados oriundos da avaliação das concentrações de citocinas ao longo do tempo, foi utilizado o teste ANOVA com medidas repetidas. Para todas as análises realizadas foi adotado nível de significância de 5%. RESULTADOS: no grupo de recém-nascidos com sepse e boa evolução, os níveis séricos de TNF-±; IL-1² e Il-10 se apresentaram próximos aos valores mínimos detectáveis pelo método, e nos RN com sepse grave, esses níveis foram estatisticamente superiores (p;1) e da resposta antiinflamatória nos dia 3 e 7 de evolução (razão ;1) e somente no dia 7, houve predomínio da ação antiinflamatória (razão ;1, com inversão nos dias 3 e 7). A persistência de predomínio das citocinas pró-inflamatórias em relação às antiinflamatórias no terceiro dia após o diagnóstico está correlacionada à evolução clínica desfavorável.

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Publicado

2008-08-01

Edição

v. 18 n. 2 (2008)

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Pesquisa Original

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