RESUMO
OBJECTIVE: To investigate the in vitro chemotactic function of neutrophils obtained from patients with sepsis. DESIGN: Prospective study in which purified neutrophils obtained from septic patients and nonseptic control volunteers were assayed for chemotactic function induced by N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP) and leukotriene B4. The sera nitrate concentrations also were quantified. SETTING: University hospital. PATIENTS: Twenty patients with sepsis caused by different infectious foci. INTERVENTIONS: Routine blood tests, blood or other site cultures, blood collection for neutrophil purification sera collection for nitrate assay. MEASUREMENTS AND MAIN RESULTS: Neutrophils from septic patients exhibited significantly less chemotactic activity than neutrophils obtained from healthy volunteers, in response to FMLP (93.4 +/- 6.6 vs. 51 +/- 8.3 migrated neutrophils) and leukotriene B4 (90.2 +/- 10 vs. 42.4 +/- 11.6 migrated neutrophils) stimuli, in a microchemotaxis chamber assay. The impaired chemotaxis occurred mainly in neutrophils from nonsurvivor patients. The extent of neutrophil chemotaxis inhibition (survivor/nonsurvivor) was 33.43%/61.67% and 43.4%/86.98%, in response to FMLP and leukotriene B4, respectively. Increased serum nitrate (micromoles of NO2 + NO3) concentrations were detected in septic patients, compared with controls, but no differences were found between survivor (91.84 +/- 14.12) and nonsurvivor (102.6 +/- 17.36) groups. CONCLUSIONS: Septic patients present suppressed neutrophil chemotactic responses to FMLP and leukotriene B4 stimuli compared with healthy controls. This is accompanied by increased serum concentrations of nitrate. The impairment of neutrophil chemotaxis was observed mainly in the cells obtained from nonsurvivor patients and may thus be an additional factor contributing to disease outcome.
Assuntos
Quimiotaxia de Leucócito , Neutrófilos/fisiologia , Sepse/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leucotrieno B4/farmacologia , Masculino , Pessoa de Meia-Idade , N-Formilmetionina Leucil-Fenilalanina/farmacologia , Nitratos/sangue , Prognóstico , Estudos Prospectivos , Sepse/mortalidadeRESUMO
Os autores relatam o caso de uma criança, cuja mãe era portadora de Lupus Eritematoso Sistêmico. Já no oitavo mês de gestação, o obstetra detectou uma importante bradicardia fetal. No nono mês, a criança nasceu com bloqueio atrioventricular total (BAV) e baixo débito, tendo sido necessário o implante de marcapasso definitivo endocárdico, no mesmo dia do nascimento. Em decorrência do surgimento de endocardite, aquele marcapasso foi substituído por um epimiocárdico. Os autores chamam a atenção para os casos de bloqueio atrioventricular total (BAV) congênito associado à miocardite por Lúpus Eritematoso Neonatal, os quais, se não tratados precocemente, são fatores causais de alta mortalidade perinatal
