日本未熟児新生児学会雑誌　第26巻第2号　64～68頁（2014年）

日本未熟児新生児学会雑誌　26(2)：294-298；2014　

受付日：平成25．04．01

受理日：平成25．12．27

血中炎症性サイトカインの推移を観察し得た修正在胎期間35週1日に発症した晩期循環不全の1例

Serial Measurement of Serum Inflammatory Cytokines for a Case of Preterm Infant with Late-Onset Circulatory Dysfunction Complicated with Periventricular Leukomalacia

＊1独立行政法人国立病院機構西埼玉中央病院　周産期母子医療センター　小児科，＊2東海大学　総合周産期母子医療センター　新生児部門，＊3武蔵野赤十字病院　新生児科，＊4所沢市民医療センター　小児科

＊1Department of Pediatrics, National Organization Hospital Nishisaitama―Chuo National Hospital, ＊2Department of Neonatology, Tokai University Hospital, ＊3Department of Neonatology, Japanese Red Cross Musashino Hospital, ＊4Department of Pediatrics, Tokorozawa City Hospital

中村利彦＊1＊2・畠中大輔＊1＊3・吉岡寿朗＊1＊4

Toshihiko NAKAMURA＊1＊2，Daisuke HATANAKA＊1＊3，Toshiro YOSHIOKA＊1＊4

Key Words：periventricular leukomalacia，late-onset circulatory dysfunction，inflammatory cytokine，vascular permeability

　晩期循環不全（late-onset circulatory dysfunction：LCD）の経過における炎症性サイトカインの検討はこれまでにない。今回，既報において修正在胎期間として最も遅い，35週1日発症のLCDを経験した。ステロイド投与により，LCD発症時に一時途絶した前大脳動脈（ACA）の拡張期の血流は改善したが，治療後に，脳室周囲白質軟化症（periventricular leukomalacia：PVL）を合併した。経過中，9種の炎症性サイトカインを測定し，血管透過性亢進に関与するIL-1βとIL-8，および抗炎症性サイトカインIL-10が治療前に上昇していることが判明した。炎症性サイトカインのLCD発症への関与，さらにはPVL 合併との関連について考察した。

　We reported a case of late-onset circulatory dysfunction（LCD）of premature infant. She was born at 28 weeks of gestation, weighing at 1,071 gram. At the 39th day of life, she was extubated and put on n-CPAP for 3days. On day 45（ her corrected gestational age was 35 weeks 1 day, the latest time of LCD onset in reported case in Japan）, she developed hypotension, oliguria and hyponatremia. We administrated 0.5 mg/kg/day of dexamethasone intravenously on day 45 and diminished until day 50. All of her problems were dissolved but she developed periventricular leukomalacia far later. We measured serial concentration of serum cytokines. These were nine kinds of inflammatory cytokines, some of which were factor of vessel permeability. IL-1beta, IL-8 and IL-10 were elevated before treatment. This is the first case reported measurement of cytokine with LCD. We postulate that there is some relationship between PVL with LCD and inflammatory cytokines such as IL-1beta and IL-8. More studies are needed to establish the pathogenesis.