In einer prospektiven Studie wurden bei 28 kritisch kranken Patienten einer interdisziplinären Intensivstation die Plasmaspiegel von TNF[alpha], sCD14, Interleukin-6 (IL-6), sICAM-1 und sE-Selektin gemessen. Ziel der Studie war es, die genannten Parameter in ihrer Wertigkeit als Frühparameter der Sepsis zu untersuchen. Die Plasmaspiegel der Parameter TNF[alpha], IL-6, sCD14, sICAM-1 und sE-Selektin wurden mittels ELISA-Testkits bestimmt. Insgesamt wurde in einem Zeitraum von 11 Beobachtungstagen täglich 10 ml Blut entnommen, zentrifugiert und bis zur Verarbeitung tiefgefroren. Gruppe 1:Patienten mit einer mikrobiellen Infektion, die im Beobachtungszeitraum keine Sepsis entwickelten. Alle Patienten dieser Gruppe überlebten,Gruppe 2:Patienten mit einer mikrobiellen Infektion, die im Beobachtungszeitraum eine Sepsis mit Organdysfunktion entwickelt haben und überlebten, / In a prospective study, we determined the plasma levels of TNF[alpha], sCD14, Interleukin-6 (IL 6), sICAM-1 and sE-Selectin of 28 critically ill patients on our interdisciplinary intensive care unit. The aim of our study was to find out if these parameters are valuable for the early diagnosis of septicaemia. Plasma levels of TNF[alpha], IL-6, sCD14, sICAM-1 and sE-Selectin were measured with ELISA-test-kits. In a period of 11 days, we took 10 ml of blood daily which was refrigerated until examination. GROUP 1:patients with bacterial infections who did not develop septicaemia. All of these patients survived.GROUP 2:patients with bacterial infections who presented with symptoms of disturbed organic function within the examination period and survived.GROUP 3: patients with bacterial infections who developped symptoms of severe septicaemia and died because of multiple organic failure. Results: In patients with septicaemia, TNF[alpha]-levels were significantly higher than in patients without septicaemia. TNF[alpha]-levels can not be used as prognostic parameters in septicaemia because of the short half-life-time.sCD14-levels were significantly higher in patients with septicaemia in the first two days of observation. sCD14-levels can not be used as a prognostic criteria in septicaemia.In patients with septicaemia, we found significant higher Interleucin-6-levels compareed to patients without septicaemia. IL6 prooved to be a good marker for septicaemia. In combination with plasma levels of Se_Selectin, it is criteria for severity of the septicaemia and propable outcome of patients.Pathologically high plasma levels of sICAM-1 were measured in patients with septicaemia. S-ICAM-1 is an early indicator for activation of withe blood cells and danger of septicaemia. The exact blood level of s-ICAM-1 did not correlate with the outcome of patients.sE-Selectin-levels were significantly higher in patients with septicaemia than in patients without septicaemia. The persistence of high sE-Selectin levels indicates possible septicaemia early and is correlated with the outcome of patients.

Submitted by VANESSA MARTINEZ MANFIO null (vanessamanfio@hotmail.com) on 2016-03-21T11:01:26Z No. of bitstreams: 1 Dissertação_Vanessa VERSÃO FINAL.pdf: 1164639 bytes, checksum: d6a956dc11e0ba499b927c97079acc72 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-03-22T13:38:55Z (GMT) No. of bitstreams: 1 manfio_vm_me_botu.pdf: 1164639 bytes, checksum: d6a956dc11e0ba499b927c97079acc72 (MD5) / Made available in DSpace on 2016-03-22T13:38:55Z (GMT). No. of bitstreams: 1 manfio_vm_me_botu.pdf: 1164639 bytes, checksum: d6a956dc11e0ba499b927c97079acc72 (MD5) Previous issue date: 2016-02-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: aproximadamente 39.000.000 de pessoas vivem com HIV/aids no mundo, sendo 757.042 no Brasil, notificados desde 1980 até junho de 2014, e estima-se 12.000 casos de mulheres gestantes infectadas por ano. Na infecção pelo HIV, além da depleção intensa de linfócitos T CD4+ no intestino, ocorre comprometimento de vários mecanismos protetores epiteliais, fatores que causam danos na barreira intestinal e resultam na translocação microbiana, induzindo aumento da ativação imune sistêmica e inflamação crônica. No entanto, a translocação microbiana na infecção pelo HIV tem sido pouco investigada durante a gestação, período em que a mulher é suscetível a infecções bacterianas. Objetivo: estudar marcadores de translocação microbiana e inflamação em gravidas infectadas pelo HIV. Casuística e métodos: foram estudadas 30 voluntárias, sendo 12 gestantes infectadas pelo HIV (G1), 10 gestantes não infectadas (G2) e, oito mulheres infectadas pelo HIV não grávidas (G3), mas dentro da faixa etária reprodutiva. Foram coletados dados referentes à idade, idade gestacional (IG), carga viral plasmática do HIV (CV), contagem de linfócitos T CD4+ e nadir de T CD4+. A translocação microbiana foi avaliada por dosagem plasmática de CD14 solúvel (sCD14) pelo método imunoenzimático (ELISA) e, o estado inflamatório, pela análise de IL- 17, IL-10, IL-8, IL-1β, IL-6, IL-12p70 e TNF-α por citometria de fluxo (CBA). Para a análise estatística paramétrica foi utilizado o teste ANOVA, seguido de Tukey-Kramer e, para as não paramétricas, Distribuição Gamma, considerando diferenças significativas quando p<0,05. Resultados: a média de T CD4+, CV e nadir foram, respectivamente, para G1, 601 células/mm³, 25670 cópias/mL e 442 células/mm³ e, para G3, 583 células/mm³, 2299 cópias/mL e 196 células/mm³. Em relação à idade, os grupos diferiram entre si, sendo menor em G1 e maior em G3. Não houve diferenças nas dosagens de citocinas. Foram observados níveis elevados de sCD14 em todos os grupos, havendo diferença entre G1 (6727±2030) e G3 (11515±10746), [p=0,02] e entre G2 (5456±769) e G3 [p<0,001]. Conclusão: Embora não tenha ocorrido diferença no estado inflamatório entre os grupos, todas as gestantes mostraram níveis elevados de sCD14, independente da presença ou não da infecção pelo HIV, porém, os maiores valores foram das mulheres infectadas e não gestantes, sugerindo que a gravidez poderia influenciar em mecanismos de translocação, alterando, especialmente os níveis do marcados estudado. / Introduction: Approximately 39.000.000 million people are living with HIV/AIDS worldwide and 757.042 in Brazil, reported from 1980 to June 2014, and it is estimated 12.000 cases of HIV-infected pregnant women annually. In HIV infection, besides the intense basal CD4+ T lymphocytes depletion, occurs impairment of various epithelial protective mechanisms, factors that contribute to intestinal barrier damages and result in microbial translocation, leading to increased systemic immune activation and chronic inflammation. However, microbial translocation in HIV infection has been poorly investigated during pregnancy, period which women are susceptible to bacterial infections. Objective: to study microbial translocation markers and the inflammatory status in HIV-infected pregnant women. Patients and Methods: We studied 30 volunteers, 12 HIV-infected pregnant women (G1), 10 HIV-uninfected pregnant women (G2) and 8 HIV-infected nonpregnant women (G3) in the same reproductive age than the other groups. Data were collected regarding age, gestational age (GA), plasma HIV viral load (VL), lymphocyte CD4+ T count and nadir. The microbial translocation was evaluated by measurement of plasmatic soluble CD14 (sCD14), performing the immunoenzymatic method (ELISA) and of inflammatory cytokines (IL-17, IL-10, IL-8, IL-1β, IL-6, IL -12p70 and TNF-α) by flow cytometry (CBA). The parametric statistical analysis was performed using ANOVA followed by Tukey-Kramer post-hoc test, and for non-parametric, Gamma Distribution, considered significant when p <0.05. Results: The mean of CD4+ T count, nadir and VL were, respectively for G1 601 cells/mm³, 442 cells/mm³ and 25670 copies/mL, and for G3, 583 cells/mm³, 196 cells/mm³ and 2299 copies/mL. The age was different between G1 and G3. Plasmatic levels of cytokines did not differ among groups. High levels of sCD14 were observed in all groups, with statistical difference between G1 (6727±2030) and G3 (11515±10746) [p = 0.02] and G2 (5256±769) and G3 [p <0.001]. Conclusion: Although there was no difference in the inflammatory state between the groups, all pregnant women showed high levels of sCD14, those HIV-infected and uninfected, however, the HIV-infected non-pregnant women showed the highest values of this marker, suggesting that the pregnancy might influence on translocation mechanisms, changing the plasmatic sCD14 values.

No description available.