Chiu Chih-Yung, Wong Kin-Sun, Huang Jing-Long, Tasi Ming-Han, Lin Tzou-Yien, Hsieh Sen-Yung
Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
Pediatr Infect Dis J. 2008 Aug;27(8):699-703. doi: 10.1097/INF.0b013e318170b678.
In children, pleural empyema is a recognized complication of severe pneumonia and is characterized by loculated effusions with fibrin septations. The aim of this study was to evaluate the relationship between proinflammatory cytokines [tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and IL-6], intrapleural fibrinolytic system enzymes [tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1)], and common biochemical indices during pleural infection.
Children with pneumonia complicated by para-pneumonic effusions were enrolled into our study and underwent real-time chest sonography. The patients were divided into 3 groups by ultrasound using a recognized staging system of pleural effusions. Staging of progressive pleural infection was used to correlate with the characteristics of pleural effusions. The correlation of various pleural variables with the formation of complicated para-pneumonic effusions (CPE) was performed and pleural variables for predicting subsequent intervention procedures were also analyzed.
A total of 57 patients were enrolled in the present study. Univariate analysis revealed that the amounts of biochemical indices (pH, glucose, lactate dehydrogenase), proinflammatory cytokines (TNF-alpha, IL-1beta, IL-6), and fibrinolytic system enzymes (tPA, PAI-1) were significantly different with the progressive stages of para-pneumonic effusions (Ptrend < 0.05). For all proinflammatory cytokines, a positive correlation was found with lactate dehydrogenase and PAI-1, whereas a negative correlation was found with pH, glucose, and tPA. Moreover, these cytokines were also significantly correlated with PAI-1 in both non-CPE and CPE. The pleural fluid findings of IL-1beta (> or =50 pg/mL), PAI-1 (> or =1252 ng/mL), and pH (< or =7.30) were the most significant predictive factors for subsequent intervention procedures (P < 0.001).
The increased release of proinflammatory cytokines in pleural fluid caused by bacteria may result in an imbalance of the fibrinolytic system, which can subsequently lead to fibrin deposition and intervention procedures.
在儿童中，胸膜腔积脓是重症肺炎公认的并发症，其特征为伴有纤维分隔的包裹性胸腔积液。本研究旨在评估促炎细胞因子[肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和IL-6]、胸膜腔内纤溶系统酶[组织型纤溶酶原激活物（tPA）和纤溶酶原激活物抑制剂1型（PAI-1）]与胸膜感染期间常见生化指标之间的关系。
将肺炎合并类肺炎性胸腔积液的儿童纳入本研究，并接受实时胸部超声检查。采用公认的胸腔积液分期系统通过超声将患者分为3组。使用进行性胸膜感染分期来关联胸腔积液的特征。对各种胸膜变量与复杂性类肺炎性胸腔积液（CPE）形成的相关性进行分析，并分析预测后续干预措施的胸膜变量。
本研究共纳入57例患者。单因素分析显示，生化指标（pH值、葡萄糖、乳酸脱氢酶）、促炎细胞因子（TNF-α、IL-1β、IL-6）和纤溶系统酶（tPA、PAI-1）的量随类肺炎性胸腔积液的进展阶段有显著差异（Ptrend< 0.05）。对于所有促炎细胞因子，发现与乳酸脱氢酶和PAI-1呈正相关，而与pH值、葡萄糖和tPA呈负相关。此外，这些细胞因子在非CPE和CPE中也与PAI-1显著相关。IL-1β（≥50 pg/mL）、PAI-1（≥1252 ng/mL）和pH值（≤7.30）的胸腔积液结果是后续干预措施最显著的预测因素（P<0.001）。
细菌引起的胸腔积液中促炎细胞因子释放增加可能导致纤溶系统失衡，进而导致纤维蛋白沉积和干预措施。
