Farah Raymond, Makhoul Nicola
Department of Internal Medicine B, Ziv Medical Center, Safed, Israel.
Isr Med Assoc J. 2011 Apr;13(4):225-9.
Community-acquired pneumonia requiring hospitalization is a severe illness with high mortality, especially if the appropriate treatment is delayed. Sometimes diagnosis is difficult due to an equivocal clinical picture or chest film, or to accompanying diseases that mask or simulate pneumonia.
To assess the usefulness of certain inflammatory markers in differentiating pulmonary edema from pneumonia throughout the hospital stay in patients admitted for pneumonia or pulmonary edema of non-infectious origin and to monitor the response to treatment.
The study group comprised 50 patients admitted for pneumonia, 50 admitted for pulmonary edema and 30 healthy individuals. Blood samples for determination of leukocyte count, erythrocyte sedimentation rate (ESR), fibrinogen, C-reactive protein (CRP), albumin, sCD14 and oxidized fibrinogen were drawn upon admission, at 48 and 72 hours after admission, and at discharge from the intensive care unit.
The levels of sCD14 were similar in both patient groups but higher than control levels during the first 48 hours (P< 0.03). They decreased gradually with hospital stay. The concentration of oxidized fibrinogen was similar in both patient groups and significantly lower than that of the healthy control group throughout the hospitalization period.
Oxidized fibrinogen and sCD14 are not reliable markers for the diagnosis of pneumonia, for its differential diagnosis from pulmonary edema, and for patient follow-up throughout hospitalization. The finding of elevated levels of oxidized fibrinogen in the group of healthy controls warrants further study to identify the factors responsible for altering fibrinogen oxidation. The other markers are more indicative.
需住院治疗的社区获得性肺炎是一种严重疾病，死亡率高，尤其是在适当治疗延迟的情况下。有时，由于临床表现或胸部X光片不明确，或伴有掩盖或模拟肺炎的疾病，诊断会很困难。
评估某些炎症标志物在区分肺炎与肺水肿方面的作用，这些患者因肺炎或非感染性肺水肿入院，整个住院期间进行监测，并评估其对治疗的反应。
研究组包括50例因肺炎入院的患者、50例因肺水肿入院的患者和30名健康个体。在入院时、入院后48小时和72小时以及重症监护病房出院时采集血样，用于测定白细胞计数、红细胞沉降率（ESR）、纤维蛋白原、C反应蛋白（CRP）、白蛋白、可溶性CD14（sCD14）和氧化纤维蛋白原。
两组患者的sCD14水平相似，但在最初48小时内高于对照组水平（P<0.03）。随着住院时间的延长，其水平逐渐下降。两组患者氧化纤维蛋白原的浓度相似，且在整个住院期间均显著低于健康对照组。
氧化纤维蛋白原和sCD14不是诊断肺炎、将其与肺水肿进行鉴别诊断以及在整个住院期间对患者进行随访的可靠标志物。健康对照组中氧化纤维蛋白原水平升高这一发现值得进一步研究，以确定导致纤维蛋白原氧化改变的因素。其他标志物更具指示性。
