Department of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
J Infect Dis. 2010 Nov 1;202(9):1454-62. doi: 10.1086/656527.
Monitoring treatment response in invasive aspergillosis is challenging, because an immunocompromised host may not exhibit reliable symptoms and clinical signs. Cytokines play a pivotal role in mediating host immune response to infection; therefore, the profiling of biomarkers may be an appropriate surrogate for disease status.
We studied, in a cohort of 119 patients with invasive aspergillosis who were recruited in a multicenter clinical trial, serum interleukin (IL)-6, IL‐8, IL‐10, interferon‐γ, and C‐reactive protein (CRP) trends over the first 4 weeks of therapy and correlated these trends to clinical outcome parameters.
Circulating IL‐6 and CRP levels were high at initiation of therapy and generally showed a downward trend with antifungal treatment. However, subjects with adverse outcomes exhibited a distinct lack of decline in IL‐6 and CRP levels at week 1, compared with responders (P = .02, for both IL‐6 and CRP). Nonresponders also had significantly elevated IL‐8 levels (P = .001).
High initial IL‐8 and persistently elevated IL‐6, IL‐8, and CRP levels after initiation of treatment may be early predictors of adverse outcome in invasive aspergillosis. Cytokine and CRP profiles could be used for early identification of patients with a poor response to antifungal treatment who may benefit from more‐aggressive antimicrobial regimens.
监测侵袭性曲霉病的治疗反应具有挑战性，因为免疫功能低下的宿主可能没有可靠的症状和临床体征。细胞因子在介导宿主对感染的免疫反应中起着关键作用；因此，生物标志物的分析可能是疾病状态的合适替代指标。
我们研究了在一项多中心临床试验中招募的 119 例侵袭性曲霉病患者的队列中，血清白细胞介素 (IL)-6、IL-8、IL-10、干扰素-γ 和 C 反应蛋白 (CRP) 在治疗的前 4 周的趋势，并将这些趋势与临床结果参数相关联。
治疗开始时循环 IL-6 和 CRP 水平较高，通常随着抗真菌治疗呈下降趋势。然而，与反应者相比，不良结局患者在第 1 周时 IL-6 和 CRP 水平明显没有下降（P =.02，IL-6 和 CRP 均如此）。非反应者的 IL-8 水平也显著升高（P =.001）。
治疗开始时初始 IL-8 水平较高且治疗后 IL-6、IL-8 和 CRP 水平持续升高可能是侵袭性曲霉病不良结局的早期预测指标。细胞因子和 CRP 谱可用于早期识别对抗真菌治疗反应不佳的患者，这些患者可能受益于更积极的抗菌治疗方案。
