Michelow Ian C, Katz Kathy, McCracken George H, Hardy R Doug
Department of Pediatrics (Divisions of Infectious Diseases), University of Texas Southwestern Medical Center, Dallas, TX, USA.
Pediatr Pulmonol. 2007 Jul;42(7):640-5. doi: 10.1002/ppul.20633.
Characterization of the systemic cytokine response in community-acquired pneumonia (CAP) may facilitate our understanding of the host immune response and provide a prognostic as well as diagnostic tool. Systemic cytokine characterization of CAP has been limited largely to a few integral cytokines in adults.
Analyses were performed to investigate whether significant relationships existed between an expanded serum cytokine profile and etiologies, manifestations, and outcomes of pediatric CAP. The serum concentrations of 15 cytokines were investigated in 55 hospitalized children with well-characterized CAP.
Comparison of median cytokine concentrations among patients with CAP caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae, Streptococcus pneumoniae, viruses, mixed infections, or unidentified pathogens revealed significant differences in IFN-alpha, IL-6, IL-17, GM-CSF, and TNF-alpha concentrations. The mixed infections category had significantly elevated concentrations of IFN-alpha, IL-6, GM-CSF, and TNF-alpha. There were significant correlations between concentrations of IL-6 and markers of disease severity (white blood cell band-forms, procalcitonin, and unequivocal consolidation). No single cytokine could reliably differentiate the etiologic cause of pneumonia.
IL-6 is the only one of 15 serum cytokines studied that correlated with indicators of disease severity in childhood CAP. The applicability of cytokine profiles to identify microbiologic etiologies of pneumonia remains to be defined.
对社区获得性肺炎（CAP）患者的全身细胞因子反应进行特征分析，可能有助于我们理解宿主免疫反应，并提供一种预后及诊断工具。CAP患者全身细胞因子特征分析在很大程度上局限于成人的少数几种重要细胞因子。
进行分析以调查血清细胞因子谱的扩展与儿童CAP的病因、表现及预后之间是否存在显著关联。对55例确诊为CAP的住院儿童的血清15种细胞因子浓度进行了研究。
比较由肺炎支原体或肺炎衣原体、肺炎链球菌、病毒、混合感染或不明病原体引起的CAP患者的细胞因子中位数浓度，发现干扰素-α、白细胞介素-6、白细胞介素-17、粒细胞-巨噬细胞集落刺激因子和肿瘤坏死因子-α浓度存在显著差异。混合感染组的干扰素-α、白细胞介素-6、粒细胞-巨噬细胞集落刺激因子和肿瘤坏死因子-α浓度显著升高。白细胞介素-6浓度与疾病严重程度指标（白细胞杆状核、降钙素原和明确的实变）之间存在显著相关性。没有单一细胞因子能够可靠地区分肺炎的病因。
白细胞介素-6是所研究的15种血清细胞因子中唯一与儿童CAP疾病严重程度指标相关的细胞因子。细胞因子谱用于识别肺炎微生物病因的适用性仍有待确定。
