新生儿脓毒症.pptVIP

Cell Surface Markers and Granulocyte Colony Stimulating Factors Neutrophil CD 11b and CD 64 appear to be promising markers. CD 64 had sensitivity of 80% and specificity of 79% in culture proven sepsis. CD 11b had a sensitivity of 96- 100% and specificity of 81- 100% in culture proven sepsis. GSF, mediator produced by the bone marrow facilitates proliferation of neutrophils in sepsis. A concentration of 200pg/ml has a sensitivity of 95% and specificity of 99%. Procalcitonin (PCT) PCT is produced by the monocytes and hepatocytes and is propeptide of calcitonin. PCT rises 4-6 hours after exposure to bacterial endotoxin peaking at 6- 8 hours. Half life of PCT 25- 30 hours. Elevated concentrations are found in RDS, IDM and hemodynamically unstable infants. PCT values of 2.3ng/ ml and CRP 30mg/ L indicates a high likely hood of late onset sepsis. CRP Concentration in Sepsis(Sensitivity, Specificity, Predictive Values) Serial measurements in early and late onset sepsis showed the best cut off value of 10mg/ L (Stanford) CRP concentration was normal in 30% of all sepsis episodes. PPV was 5% for culture proven early onset sepsis and 43% in late onset sepsis. Greater elevation in CRP concentrations were associated with higher probability of infection. Negative predictive value was highest both for early and late onset sepsis after three values (99.7 and 98.7) Two CRP concentration 10mg/ L obtained 24 hours apart makes sepsis unlikely. Benitz et al. Pediatrics. 1998;102:e41 C-reactive Protein:rate Nephalometry NeoReviews, 2005;6:e508-515 Light scattered is Proportional to concentration of antigen Factors That Can InfluenceCRP Values Mode of delivery Gestational age Type of organism causing sepsis Granulocytopenia Surgery Immunizations Severe viral infections (eg, herpes simplex virus, rotavirus, influenza) NeoReviews, 2005;6:e508-515 Cytokines in Sepsis Cytokines mediate communication between cells of the body by binding to