小児期の炎症性疾患の病態変化と検査値とのかかわり

Inflammatory processes of diseases in childhood and laboratory parameters

小児期の疾患の多くに炎症がかかわっており，炎症の直接の誘因は炎症性サイトカインである．炎症性サイトカインは発熱，食思不振，傾眠傾向などの臨床症状とともにCRP，アミロイドAなどを誘導する．過剰な炎症性サイトカインは血管内皮細胞を活性化し，さらに進展すると内皮細胞の破綻を契機として凝固線溶系が活性化される．炎症が持続すると播種性血管内凝固症候群から多臓器不全という炎症の最終段階に至り，その結果，炎症死となる．個々の段階に応じて血液検査上に時々刻々変化が生じるので，ベッドサイドでは，この変化を逃さずとらえ治療介入を行うことで，病態の進行を止めることができる．

Most diseases in childhood are caused by inflammatory processes such as infectious diseases, allergic disorders, and rheumatic diseases, and the inflammation is derived from pro-inflammatory cytokines.　Pro-inflammatory cytokines induce fevers, loss of appetite and sleep, and lead liver cells to produce CRP and serum amyloid A.　Moreover, excessive amounts of pro-inflammatory cytokines activate endothelial cells resulting in a rupture, and then activate coagulation system.　The continuity of excessive pro-inflammatory cytokines in peripheral blood is then related to the progression of disseminated intravascular coagulopathy and multiple oxgan failure which is the causes of "inflammatory death".　At the bedside, intensive monitor of laboratory parameters will be helpful to make an appropriate decision of therapy in time, and to cease the progressive processes.