#16
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Âñå òàêè õîòåëîñü áû óçíàòü äèçàéí èññëåäîâàíèÿ - ïàðàìåòðû ýôôåêòèâíîñòè, ñ êåì ïðîâîäèëîñü ñðàâíåíèå, èñïîëüçîâàëàñü ëè ðàíäîìèçàöèÿ, ïðåäâàðèòåëüíûå ðåçóëüòàòû.
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#17
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Òåìà çàãëîõëà íà ñàìîì èíòåðåñíîì ìåñòå... Âñå òàêè õîòåëîñü áû ïðîäîëæåíèÿ!
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#18
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Äà âðÿä ëè áóäåò ïðîäîëæåíèå, âåäü äàæå íà ÿíâàðü 2003:
IL-2 has not been studied in pregnant women. In studies, women who become pregnant must stop IL-2 but can remain in the study. IL-2 can raise bilirubin levels which may cause serious harm to the developing child. Studies of IL-2 in children are just beginning to enroll throughout the United States. Èç [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïîýòîìó ïðèìåíÿòü ðîíêîëåéêèí ó íîâîðîæäåííûõ äà åùå â òå÷åíèå 5 ëåò (äóìàþ, áåç ñîãëàñèÿ ðîäèòåëåé) Âû ñàìè çíàåòå êàê ýòî íàçûâàåòñÿ â ìåäèöèíå. |
#19
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èììóíîêîððåêöèÿ ó íîâîðîæäåííûõ
"Ôèëãðàñòèì â òåðàïèè ñåïñèñà ó íîâîðîæäåííûõ
Îïóáëèêîâàíî: 18 Ñåí, 2003 ã. - 12:58 webmaster Òåìà: Èììóíîëîãèÿ è èììóíîïðîôèëàêòèêàÐàçäåë: Ñòàòüè Öèòîêèíîâàÿ òåðàïèÿ ôèëãðàñòèíîì - ðåêîìáèíàíòíûì ãðàíóëîöèòàðíûì êîëîíèåñòèìóëèðóþùèì ôàêòîðîì - ìîæåò îêàçàòü ïîëîæèòåëüíûé ýôôåêò ïðè ñåïñèñå ó íåäîíîøåííûõ íîâîðîæäåííûõ ñ íåéòðîïåíèåé.  ïðîâåäåííîì â Âåëèêîáðèòàíèè èññëåäîâàíèè 28 íîâîðîæäåííûõ (ãåñòàöèîííûé âîçðàñò ìåíåå 32 íåäåëü) ñ ñåïñèñîì ïðè óðîâíå àáñîëþòíîãî êîëè÷åñòâà íåéòðîôèëîâ (ÀÊÍ) < 1000/ìì3 ïîëó÷àëè ôèëãðàñòèì («Neupogen») â äîçå 5 ìêã/êã (n=10) èëè ñàðãðàìîñòèì (ðåêîìáèíàíòíûé ÷åëîâå÷åñêèé ãðàíóëîöèòîìàêðîôàãàëüíûé êîëîíèåñòèìóëèðóþùèé ôàêòîð; «Leukine») â äîçå 4 ìêã/êã (n=10), èëè ïëàöåáî 2 ðàçà â äåíü (n=8). Ëå÷åíèå íàçíà÷àëîñü â òå÷åíèå 7 äíåé èëè äî ïîâûøåíèÿ ÀÊÍ äî óðîâíÿ 10000/ìì3 è áîëåå. Çíà÷èòåëüíîå óâåëè÷åíèå ÀÊÍ íàáëþäàëîñü â áîëåå ðàííèå ñðîêè ó ïàöèåíòîâ, ïîëó÷àâøèõ ôèëãðàñòèì (íà 2 äåíü), ïî ñðàâíåíèþ ñ ïàöèåíòàìè, ïîëó÷àâøèìè ñàðãðàìîñòèì (íà 5 ñóòêè) èëè ïëàöåáî (íà 5 ñóòêè). Êðîìå òîãî, ÀÊÍ ó ïàöèåíòîâ, ïîëó÷àâøèõ ôèëãðàñòèì, íà 7 äåíü òåðàïèè áûëî çíà÷èòåëüíî âûøå ïî ñðàâíåíèþ ñ òàêîâûì ó ïàöèåíòîâ, ïîëó÷àâøèõ ñàðãðàìîñòèì èëè ïëàöåáî (23866/ìì3, 12681/ìì3 è 9518/ìì3, ñîîòâåòñòâåííî). Äâîå íîâîðîæäåííûõ, ïîëó÷àâøèõ ôèëãðàñòèì è îäèí, ïîëó÷àâøèé ñàðãðàìîñòèì, ïîãèáëè âî âðåìÿ ïðîâåäåíèÿ öèòîêèíîâîé òåðàïèè. Õîòÿ íå áûëî çíà÷èòåëüíûõ ìåæãðóïïîâûõ ðàçëè÷èé â óðîâíÿõ çàáîëåâàåìîñòè è ñìåðòíîñòè, áûëà îòìå÷åíà òåíäåíöèÿ ê ñíèæåíèþ ÷àñòîòû ïîñëåäóþùèõ íîçîêîìèàëüíûõ èíôåêöèé ó ïàöèåíòîâ, ïîëó÷àâøèõ ôèëãðàñòèì, ïî ñðàâíåíèþ ñ ïîëó÷àâøèìè ïëàöåáî. Êðîìå òîãî, èññëåäîâàòåëè îòìå÷àþò, ÷òî âñå 5 ïàöèåíòîâ ñ ïîäòâåðæäåííîé ñåïòèöåìèåé, âûçâàííîé ãðàì-îòðèöàòåëüíûìè áàêòåðèÿìè, ïîëó÷àâøèå ôèëãðàñòèì, âûæèëè." Ïðèâåòñòâóþ îñòàâøèõñÿ â æèâûõ! Êàê âèäèòå, â Àíãëèè òîæå ÿâëÿåòñÿ ïðîáëåìîé èììóíîñòèìóëèðóþùàÿ òåðàïèÿ. Îáñóæäàÿ ýòîò âèä ÂÑÏÎÌÎÃÀÒÅËÜÍÎÉ òåðàïèè, ìû äîëæíû ïîìíèòü, ÷òî äëÿ àäåêâàòíîãî èììóííîãî îòâåòà íåîáõîäèìà õîðîøàÿ ãåìîäèíàìèêà è àäåêâàòíûé êàëîðàæ, ïðîøó ïðîñòèòü çà ïîâòîðÿåìîñòü. ß óïîìèíàë îá îêòàãàìå è ïåíòàãëîáèíå - ïîõîæå ýòè ïðåïàðàòû â/â Èà íå íàøëè ïðèìåíåíèÿ â äðóãèõ êëèíèêàõ. Èëè ÿ îøèáàþñü? Ñ óâ. ÁðîíÅâ. |
#20
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Óâàæàåìûé ÁðîíÅâ!
Ñ ñåðåäèíû 90-õ ãîäîâ âëèâàþòñÿ êîëîíèåñòèìóëèðóþùèå ôàêòîðû íîâîðîæäåííûì: âûïîëíåíî îêîëî 10 êëèí. èññëåäîâàíèé è ñòîëüêî æå íàïèñàíî ðåëåâàíòíûõ îáçîðîâ. Ðåçóëüòàò ñëåäóþùèé: Carr R, Modi N, Dore C. G-CSF and GM-CSF for treating or preventing neonatal infections. Cochrane Database Syst Rev. 2003;(3):CD003066. Review. Seven treatment studies of 257 infants with suspected systemic bacterial infection and three prophylaxis studies comprising 359 neonates are analysed.Treatment studies: There is no evidence that the addition of G-CSF or GM-CSF to antibiotic therapy in preterm infants with suspected systemic infection reduces immediate all cause mortality. No significant survival advantage was seen at 14 days from the start of therapy [typical RR 0.71 (95% CI 0.38,1.33); typical RD -0.05 (95% CI -0.14, 0.04)]. However all seven of the treatment studies were small, the largest recruiting only 60 infants. The subgroup analysis of 97 infants from three treatment studies who, in addition to systemic infection, had clinically significant neutropenia (<1.7 x 10(9)/l ) at trial entry, does show a significant reduction in mortality by day 14 [RR 0.34 (95% CI 0.12, 0.92); RD -0.18 (95% CI -0.33, -0.03); NNT 6 (95% CI 3-33)].Prophylaxis studies have not demonstrated a significant reduction in mortality in neonates receiving GM-CSF [RR 0.59 (95% CI 0.24,1.44); RD -0.03 (95% CI -0.08,0.02)]. Íåò ïðåèìóùåñòâ â âûæèâàíèè ê 14 äíþ ïðè ïîäîçðåíèè íà ñèñòåìíóþ èíôåêöèþ ó íåäîíîøåííûõ, íåò çíà÷èòåëüíîãî ñíèæåíèÿ ñìåðòíîñòè ó ïîëó÷àâøèõ ãðàíóëîöèòàðíî-ìàêðîôàãàëüíûé ÊÑÔ, äîñòîâåðíî ñíèæàëàñü ñìåðòíîñòü ëèøü ó íîâîðîæäåííûõ ñ âûðàæåííîé íåéòðîïåíèåé (ìåíåå 1,7 òûñ. â ìêë). Íåîáõîäèìî ïðîâåäåíèå áîëåå êðóïíûõ äîï.èññëåäîâàíèé, îñîáåííî â ïîäãðóïïàõ íîâîðîæäåííûõ, äàáû îêîí÷àòåëüíî âûÿñíèòü ðîëü ÊÑÔ â ïðîôèëàêòèêå/áîðüáå ñ ñåïñèñîì íîâîðîæäåííûõ. Ïî âíóòðèâåííûì èììóíîãëîáóëèíàì ñëåäóþùàÿ ñòàòèñòèêà: Cochrane Database Syst Rev. 2001;(2):CD000361. Intravenous immunoglobulin for preventing infection in preterm and/or low-birth-weight infants. Ohlsson A, Lacy JB. Nineteen studies met inclusion criteria. These included aprox. 5,000 preterm and/or LBW infants and reported on at least one of the outcomes of interest for this systematic review. When all studies were combined there was a statistically significant reduction (p = 0.02) in sepsis, RR [0.85 (95% CI 0.74, 0.98)] and RD [-0.03 (95% CI 0.00, -0.05)], NNT 33.There was statistically significant between-study heterogeneity (p = 0.02). A statistically significant reduction was found for any serious infection, one or more episodes, when all studies were combined [RR 0.82 (95% CI 0.74, 0.92); RD -0.04 (95% CI -0.02, -0.06,); NNT 25 (95% CI, 16.7, 50). There was statistically significant between-study heterogeneity (p = 0.0006). There were no statistically significant differences for mortality from all causes, mortality from infection, incidence of NEC, BPD and IVH or length of hospital stay. No major adverse effects of IVIG were reported in any of the studies. Ñíèæåíèå íà 3% ñåïñèñà è íà 4 % ëþáûõ äðóãèõ èíôåêöèîííûõ ïðîöåññîâ. Íå âëèÿåò íà îáùóþ èëè îáóñëîâëåííóþ èíôåêöèåé ñìåðòíîñòü. Ïîýòîìó èõ ïðèìåíåíèå îïðåäåëÿåòñÿ/îãðàíè÷èâàåòñÿ ñðåäñòâàìè, êîòîðûìè ðàñïîëàãàþò êëèíèêè. |
#21
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Íà îáñóæäàåìûé âîïðîñ ìîæíî âåäü âçãëÿíóòü è ïîä äðóãèì óãëîì. Òîêñè÷åñêèå ýôôåêòû îäíèõ ïðèâû÷íûõ ïðåïàðàòîâ íåïëîõî èçó÷åíû (ê ïðèìåðó, [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]) âîñïðèíèìàþòñÿ êàê íåèçáåæíîå çëî âî èìÿ áëàãà è ïîâñåìåñòíî, øèðîêî èñïîëüçóþòñÿ íå òîëüêî, êîãäà íåîáõîäèìû, íî è íà âñÿêèé ñëó÷àé. Ñòàòèñòè÷åñêèå äàííûå ïî òîêñè÷åñêèì ýôôåêòàì äðóãèõ ïðåïàðàòîâ íå ñòîëü îáøèðíû, ïîýòîìó îò èõ ïðèìåíåíèÿ ñëåäóåò âîçäåðæèâàòüñÿ.
Íå ïîíÿòíî òîëüêî ïî÷åìó âîïðîñ ñ èììóíîêîððåêöèåé óïåðñÿ òîëüêî â ðîíêîëåéêèí, ïðè÷åì â ïëàíå áàêòåðèàëüíîé èíôåêöèè? Íåìíîãî îáèäíî çà íåêîòîðûå äðóãèå èíòåðëåéêèíû, èíòåðôåðîíû è ò.ï. Íå ãîâîðÿ óæ î òîì, ÷òî áîëåå ïåðñïåêòèâíû è ôèçèîëîãè÷íû ïîèñê è ðàçðàáîòêà ìåòîäèê è ïðåïàðàòîâ - èíäóêòîðîâ ñîîòâåòñòâóþùèõ ñîáñòâåííûõ öèòîêèíîâ. |
#22
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Ñïàñèáî çà äèñêóññèþ, íåìíîãî î ðîíêîëåéêèíå, ïðèìåíÿÿ åãî ìû îáÿçàòåëüíî ñòàâèëè ðîäèòåëåé â èçâåñòíîñòü. Ïðèìåíÿÿ åãî ïîáî÷íûõ ýôôåêòîâ î âðåìÿ ââåäåíèÿ íå íàáëþäàëè, íè îäèí ðåáåíîê íå ïîãèá. Äîñòàòî÷íî íåïëîõèå ðåçóëüòàòû áûëè ïîëó÷åíû ïðè ïðèìåíåíèè åãî äëèòåëüíî ó íîâîðîæäåííûõ ñ ãåïàòèòîì è îñòèîìèåëèòîì, íî ïîêà ýòî ó íàñ åäèíè÷íûå ñëó÷àè. Íàñêîëüêî ìíå èçâåñòíî, ïî ñîãëàñîâàíèþ ñ ôàðìêîìèòåòîì ïðîâîäÿòñÿ èññëåäîâàíèÿ ðîíêîëåéêèíà ó íîâîðîæäåííûõ â Ìîñêâå Äåãòÿðåâîé Ì.Â. è äàæå èìåþòñÿ ðåêîìåíäàöèè ïî åãî ïðèìåíåíèþ ïðè ñåïñèñå ó íîâîðîæäåííûõ äåòåé.
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#23
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Ðàçðåøèòå ñïðîñèòü? Íå áóäó÷è ñïåöèàëèñòîì â îáëàñòè ñåïñèñà è âîáùå â îáëàñòè ÌÊÑ è â ÷àñòíîñòè íåîíàòîëîãèè (ïðîøó ïðîùåíèÿ ÷òî âëåç) õîòåë áû ñïðîñèòü...
Èíîãäà ïðîñêàêèâàþò áîëüíûå êîòîðûì õîòåëîñü áû ïðîâåñòè èììóíîêîððåêöèþ íî íàçíà÷àòü ìåäèàòîðíóþ òåðàïèþ ñòðàøíî, îöåíèòü íàïðÿæåíèå ñîáñòâåííûõ ïðî è ïðîòèâîâñïàëèòåëüíûõ ñèñòåì íå èìååì âîçìîæíîñòè à äåéñòâîâàòü â êàêóþ ñòîðîíó êàê òî íåïîíÿòíî. ïîýòîìó ïîëüçóåìñÿ êîãäà âîçìîæíî çàìåñòèòåëüíîé òåðàïèåé èììóíîãëîáóëèíàìè... Îçûâû êîëëåã î ðîíîëåéêèíå õîðîøèå íî âñåòàêè íàâðåäèòü ñòðàøíî.... Ñïàñèáî. |
#24
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Äîáðûé äåíü !
õîòåëîñü áû îòâåòèòü íà âîïðîñ î öåëåñîîáðàçíîñòè ïðèìåíåíèÿ ðîíêîëåéêèíà ïðè ñåïñèñå. Îáùåèçâåñòíî, ÷òî ïðåäèêòîðîì ëþáîãî íåáëàãîïîëó÷èÿ, êàê òî ñòðåññ, àñôèêñèÿ, èíôåêöèÿ, ÿâëÿåòñÿ ïîâûøåíèå óðîâíÿ ÈË-6, ÈË-8 è ÔÍÎ-àëüôà. Ïðè÷åì ïîÿâëåíèå äàííûõ öèòîêèíîâ â ñûâîðîòêå êðîâè õàðàêòåðíî äëÿ ñåïñèñà, â äàííîì ñëó÷àå ïðèìåíåíèå Ðîíêîëåéêèíà îïðàâäàíî, êàê èììóíîìîäåëèðóþùåãî ñðåäñòâà. Îïûò ïðèìåíåíèÿ äàííîãî ïðåïàðàòà ïðè äàííîé ïàòîëîãèè èìååòñÿ íå òîëüêî â íàøåì ãîðîäå, åãî òàêæå ðåêîìåíäóþò âåäóùèå íåîíàòîëîãè íàøåé ñòðàíû (ñì. Âîëîäèí Í.Í., Äåãòÿðåâà Ì.Â., Ñîëäàòîâà È.Ã. è äð. "Êëèíè÷åñêàÿ ýôôåêòèâíîñòü èììóíîìîäóëèðóþùåé òåðàïèè Ðîíêîëåéêèíîì â êîìïëåêñíîé òåðàïèè íåîíàòàëüíîãî ñåïñèñà") 15 â Ìîñêâå ñîñòîèòñÿ êîíãðåññ íîâûõ òåõíîëîãèé â ïåäèàòðèè..., â ïðîãðàììå ìíîãî âîïðîñîâ, ïîñâÿùåííûõ äåòñêîé èììóíîëîãèè, àíäåþñü ïî÷åðïíóòü ìíîãî íîâîãî, èíòåðåñíî áóäåò îáñóäèòü òàêèå âîëíóþùèå âîïðîñû |
#25
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Ïðîøó ïðîùåíèÿ çà ïðîäîëæåíèå çàñîðåíèÿ ôîðóìà, ïðîñòî òåìà î÷åíü èíòåðñíàÿ....
Ïðîñòî íå ìîãó ÿ ïîíÿòü, âîò óðîâåíü TNF (ÔÍÎ) ïûòàþòñÿ ïîíèçèòü (ïåíòîêñèôèëëèíîì, àíòèòåëàìè...) à òóò ìû ââîäèì ïðîâîñïàëèòåëüíûé öèòîêèí (ìîæåò íà êàêèõ òî ñòàäèÿõ îïðàâäàííî, íî âñ ëåïóþ âñåòàêè ñòðàøíî? åùå ðàç ïðîñüòèòå çà äóðàöêèå âîïðîñû. Ñ óâàæåíèåì. |
#26
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Óâàæàåìûå êîëëåãè!
Ïîçâîëüòå âûñêàçàòü ìíåíèå ïðè âåñüìà áåãëîì è ïîâåðõíîñòíîì âçãëÿäå íà èíòåðëåéêèí-2, ñåïñèñ è ÔÍÎ. Ê ñîæàëåíèþ, ðå÷ü íå âåäó î êîíêðåòíî ðîíêîëåéêèíå è íåîíàòàëüíîì ñåïñèñå. Íàçíà÷åíèå ÈË-2 ïðèâîäèò ê àêòèâàöèè CD4+ ëèìôîöèòîâ, óâåëè÷åíèå/àêòèâàöèÿ ýòèõ æå êëåòîê íàáëþäàëîñü ïðè ñåïñèñå/ñåïòè÷åñêîì øîêå è áûëî íåáëàãîïðèÿòíûì ïðîãíîñòè÷åñêèì ôàêòîðîì, íàçíà÷åíèå áîëüøèõ äîç ÈË-2 ñîïðîâîæäàëîñü ïîäüåìîì ÔÍÎ. Àíàëèç äëèòåëüíîãî íàçíà÷åíèÿ ÈË-2 îíêîïàöèåíòàì ïîêàçàë, ÷òî íàèáîëåå âûðàæåííîå òîêñè÷åñêîå äåéñòâèå íàïîìèíàëî êàðòèíó ñåïòè÷åñêîãî øîêà; è ó 5 èç 6 ïàöèåíòîâ, ñìåðòü êîòîðûõ áûëà ñâÿçàíà ñ òîêñè÷åñêèì äåéñòâèåì ÈË-2, ðàçâèëñÿ ãðàì-ïîëîæèòåëüíûé ñåïñèñ. Ïîñëå 90-õ ãîäîâ, êîãäà ïðîôèëàêòè÷åñêîå íàçíà÷åíèå ÀÁ ñòàëî ðóòèííîé ïðàêòèêîé ïðè íàçíà÷åíèè ÈË-2, ëåòàëüíûõ ñëó÷àåâ, îáóñëîâëåííûõ ÈË-2, áîëüøå íå îòìå÷àëîñü. Ìîæíî îáâèíÿòü ìåíÿ â ìàëîêîìïåòåíòíîñòè èëè ïðåäâçÿòîì àíàëèçå, íî íè îäíîãî ïîëîæèòåëüíîãî èññëåäîâàíèÿ, ïîêàçûâàþùåãî êàêèå-ëèáî áîíóñû èëè Rationale íàçíà÷åíèÿ ÈË-2 ïðè ñåïñèñå îáíàðóæèòü íå óäàëîñü, íåñìîòðÿ íà áîëåå 10-ëåòíþþ ìèðîâóþ ïðàêòèêó ïðèìåíåíèÿ ÈË-2. |
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Çäðàâñòâóéòå, êîëëåãè! Íå ìîãó, êàê ãîâîðèòüñÿ, ìîë÷àòü, õîòÿ â òî æå âðåìÿ ñêàçàòü-òî íå÷åãî! Óðîâåíü ìåäèöèíû â íàøåì êðàþ - íå ñòîëü âûñîê, êàê ó Dilbar. Âîçâðàùàÿñü ê íà÷àëó äèñêóññèè, íå ñ÷èòàþ íóæíûì ïðè êàæäîì ãíîéíîì ïðîöåññå íàçíà÷àòü èììóíîìîäóëÿòîðû.  òî æå âðåìÿ, ïî âûðàæåíèþ ìîåãî äðóãà, "ó äåòåé ñ ñåïñèñîì ïðèìåíåíèå ïåíòàãëîáèíà äàåò íåêîòîðóþ ôîðó äëÿ àíòèáèîòèêîâ, ñíèæàåò óðîâåíü òîêñåìèè" Ïî÷åìó ìû çàìêíóëèñü íà ÈË-2? âåäü ýòî äàëåêî íå âåñü "èììóíèòåò". "Áîëüíûå äëÿ " ÈË-2 - íàâåðíîå åñòü, íî íå êàæäûé 5-é! Âîîáùå - ÷òî ìîæíî ñäåëàòü ïðè ñåïñèñå äëÿ èììóíèòåòà? Ïðåäïî÷èòàþ íå "çàñîðÿòü" åãî íåíóæíûìè ëåêàðñòâàìè, êàê íàâåðíîå è áîëüøèíñòâî âðà÷åé ìîåãî óðîâíÿ.
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#28
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Óâàæàåìûé BronEW!
À â îáùåì-òî íè÷åãî äðóãîãî íå îñòàåòñÿ: ñîîòâåòñòâóþùàÿ ÀÁ òåðàïèÿ ïëþñ/ìèíóñ ÊÑÔ, èììóíîãëîáóëèíû äà òðàíñôóçèè ãðàíóëîöèòàðíîé ìàññû, ñîãëàñíî Curr Opin Pediatr. 2003 Apr;15(2):155-60. Immunotherapy in the prophylaxis and treatment of neonatal sepsis. Suri M, Harrison L, Van de Ven C, Cairo MS. Ïîñëåäíåå, ïðàâäà â ïîäàâëÿþùåì áîëüøèíñòâå îòå÷åñòâåííûõ êëèíèê íåäîñòóïíî, òàêæå êàê è êîíöåíòðàòû àíòèòðîìáèíà èëè àêòèâèðîâàííîãî ïðîòåèíà Ñ. Êîíå÷íî, ìîæíî ïåðåíÿòü îïûò êîëëåã ïî èñïîëüçîâàíèþ ìåëàòîíèíà â äàííîé ñèòóàöèè, çäåñü õîòü êàêîå-òî ðàöèîíàëüíûé áàçèñ è ìèíèìàëüíûé ïîëîæèòåëüíûé êëèí. îïûò (êîòîðûé êñòàòè, ìîæåò è íå ïîäòâåðäèòüñÿ ïðè áîëüøåì ÷èñëå íàáëþäåíèé): Gitto E, Karbownik M, Reiter RJ, Tan DX, Cuzzocrea S, Chiurazzi P, Cordaro S, Corona G, Trimarchi G, Barberi I. Effects of melatonin treatment in septic newborns. Pediatr Res. 2001 Dec;50(6):756-60. ... Serum MDA + 4-HDA concentrations in newborns with sepsis were significantly higher than those in healthy infants without sepsis; in contrast, in septic newborns treated with melatonin there was a significant reduction (p < 0.05) of MDA + 4-HDA to the levels in the normal controls at both 1 and 4 h (p < 0.05). Melatonin also improved the clinical outcome of the septic newborns as judged by measurement of sepsis-related serum parameters after 24 and 48 h. Three of 10 septic children who were not treated with melatonin died within 72 h after diagnosis of sepsis; none of the 10 septic newborns treated with melatonin died... Fulia F, Gitto E, Cuzzocrea S, Reiter RJ, Dugo L, Gitto P, Barberi S, Cordaro S, Barberi I. Increased levels of malondialdehyde and nitrite/nitrate in the blood of asphyxiated newborns: reduction by melatonin. J Pineal Res. 2001 Nov;31(4):343-9. È óæ åñëè âëèÿòü íà ÔÍÎ è ÈË-6, òî êîíå÷íî íå èíòåðëåéêèíîì-2, à áîëåå ýôôåêòèâíî, íàïð. òåì æå ïåíòîêñèôèëëèíîì. Ïðåêðàñíàÿ äîêëèíè÷åñêàÿ áàçà, íà÷àëüíûé êëèí. îïûò è ñîîòâåòñòâóþùèé ñòàíäàðòàì EBM êëèíè÷åñêèé òðàéë: Mollitt DL, Poulos ND. The role of pentoxifylline in endotoxin-induced alterations of red cell deformability and whole blood viscosity in the neonate. J Pediatr Surg. 1991 May;26(5):572-4. Mancuso G, Blandino G, Gambuzza M, Genovese F, Migliardo M, Carbone M, Fera MT, Cusumano V. Beneficial effects of pentoxifylline in neonatal rats infected with group B streptococci. J Chemother. 1995 Oct;7(5):417-9. Lauterbach R, Pawlik D, Tomaszczyk B, Cholewa B. Pentoxifylline treatment of sepsis of premature infants: preliminary clinical observations. Eur J Pediatr. 1994 Sep;153(9):672-4. Pentoxifylline (Trental, 5 mg/kg/h for 6 h) was administered to 17 premature infants with sepsis, on 3 successive days. A statistically significant decrease in mortality rate (P < 0.04) was observed in comparison to a retrospectively analysed group of 13 septic infants, who were treated in a comparative way but without the use of a pentoxifylline infusion. The suggestion that pentoxifylline may be an effective drug in the treatment of Gram-negative sepsis in premature infants should be tested in a double-blind, randomized study. Crit Care Med. 1999 Apr;27(4):807-14. Effect of the immunomodulating agent, pentoxifylline, in the treatment of sepsis in prematurely delivered infants: a placebo-controlled, double-blind trial. Lauterbach R, Pawlik D, Kowalczyk D, Ksycinski W, Helwich E, Zembala M. Department of Neonatology, Jagiellonian University Medical College, Cracow, Poland. OBJECTIVE: To evaluate the influence of the methylxanthine derivative, pentoxifylline, on plasma levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, and IL-6 in prematurely delivered infants with generalized bacterial infections and to assess the effect of this immunomodulating drug on the clinical outcome in newborns with sepsis. DESIGN: A prospective, randomized, double-blind trial. SETTING: The neonatal intensive therapy units in university teaching hospitals. PATIENTS: One hundred patients with sepsis admitted during a 1.5-yr period. INTERVENTIONS: Patients were randomly assigned to receive pentoxifylline (pentoxifylline group) in a dose of 5 mg/kg/hr for 6 hrs on 6 successive days or an identically presented placebo (placebo group). MEASUREMENTS AND MAIN RESULTS: Only infants with sepsis confirmed by positive blood culture were recruited into the study. There were no significant differences at randomization between the pentoxifylline and placebo groups with regard to the birth weight, gestational age, gender, Apgar score, hypotension, neutropenia, thrombocytopenia, metabolic acidosis, plasma levels of cytokines, and occurrence of shock. Plasma levels of TNF, IL-1, and IL-6 were evaluated before and after the drug or placebo administration on the first, third, and sixth days of therapy. Cytokines were determined by immunoenzymetric test EASIA (TNF) and Endogen Interleukin-Elisa (IL-1, IL-6). The frequency of gram-negative sepsis was similar in both groups (37.5% and 36.8%). Pentoxifylline significantly diminished plasma TNF levels (p = .009) but had no effect on plasma IL-1 levels. Mean plasma IL-6 levels, which were measured in the pentoxifylline group on the 6th day of the study, were significantly lower compared with respective data obtained in the placebo group. Only 1 of 40 infants with sepsis in the pentoxifylline group died, whereas 6 of 38 infants in the placebo group did not survive (p = .046). An increased incidence of disordered peripheral circulation and metabolic acidosis (p = .048), anuria or oliguria (p = .03), disseminated intravascular coagulation (p = .043), and the occurrence of clinical symptoms of necrotizing enterocolitis (p = .025) was observed in the course of sepsis in infants in the placebo group. CONCLUSION: Pentoxifylline significantly affects the synthesis of TNF and IL-6 as well as reduces the mortality rate in premature infants with sepsis. The dosage and schedule of drug administration in this study attenuated the severity of the clinical course of sepsis in this group of patients. |
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ß áû ïîñîâåòîâàë ïðåæäå âñåãî íàëàäèòü ðàáîòó îòäåëåíèÿ, âêëþ÷àÿ íîðìàëüíîå ôóíêöèîíèðîâàíèå áàê.ëàáîðàòîðèèè, ðàöèîíàëüíóþ àíòèáàêòåðèàëüíóþ òåðàïèþ è ïð., à ïîòîì, åñëè ëå÷åíèå èíòðàëåéêèíîì è ïîäîáíûìè ïðåïàðàòàìè áóäåò âõîäèòü â ñòàíäàðòû òåðàïèè íîâîðîæäåííûõ ( à â íàñòîÿùåå âðåìÿ ýòî íå òàê), èñïîëüçîâàòü è åãî.
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Ñòàíäàðòû, ñòàíäàðòû.
2.10.2003: Ïî ñëîâàì ó÷åíûõ ãîñïèòàëÿ Henry Ford â Äåòðîéòå, âðà÷è äîëæíû áûòü ïðåäåëüíî âíèìàòåëüíû íàçíà÷àÿ ëåêàðñòâåííûå ïðåïàðàòû ìëàäåíöàì â âîçðàñòå äî 6 ìåñÿöåâ. Ñîãëàñíî ïðîâåäåííûì èññëåäîâàíèÿì, ó÷åíûå ïðèøëè ê çàêëþ÷åíèþ, ÷òî ïðåïàðàòû îêàçûâàþò íåáëàãîïðèÿòíîå äåéñòâèå íà ðàçâèòèå ïèùåâàðèòåëüíîé ñèñòåìû, ÷òî â äàëüíåéøåì îêàçûâàåò ñåðüåçíîå âîçäåéñòâèå íà èììóííóþ ñèñòåìó îðãàíèçìà. Âñåì äàâíî èçâåñòíî, ÷òî àíòèáèîèòêè ñïîñîáíû óíè÷òîæàòü ïîëåçíûå áàêòåðèè, ðàçìíîæàþùèåñÿ â ïèùåâàðèòåëüíîì òðàêòå îðãàíèçìà. Ñîãëàñíî ðåçóëüòàòàì ïðîâåäåííîãî èññëåäîâàíèÿ áîëåå ÷åì ó ìèëëèîíà ìàëûøåé â Ñîåäèíåííîì Êîðîëåâñòâå äèàãíîñòèðîâàíà àñòìà, òàêæå ïðîèñõîäèò ïîñòîÿííûé ðîñò àëëåðãè÷åñêèõ ðåàêöèé. Ïî ñëîâàì ðóêîâîäèòåëÿ èññëåäîâàíèÿ Christine Cole Johnson, âðà÷è äîëæíû áûòü áîëåå îñòîðîæíûìè âûïèñûâàÿ àíòèáèîòèêè â òàêîì þíîì âîçðàñòå. Êîìàíäà ñïåöèàëèñòîâ èññëåäîâàëà 448 äåòåé, ïðîñëåæèâàÿ èõ ðàçâèòèå äî ñåìèëåòíåãî âîçðàñòà. Ê 7 ãîäàì ó äåòåé, ïîëó÷èâøèõ â ïåðâûå øåñòü ìåñÿöåâ æèçíè õîòÿ áû îäèí àíòèáèîòèê ðàçâèòèå àñòìû íàáëþäàåòñÿ â 2,5 ðàçà ÷àùå, ÷åì ó äåòåé íå ïðèíèìàâøèõ àíòèáèîòèêè â ìëàäåí÷åñòâå. Áîëåå òîãî â 1,5 ðàçà ÷àùå âñòðå÷àåòñÿ ðàçâèòèå ðàçíûõ ôîðì àëëåðãèè [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |