Department of Anaesthesiology, Medical School Hannover, Germany.
Injury. 2012 Feb;43(2):189-95. doi: 10.1016/j.injury.2011.05.034. Epub 2011 Jun 23.
Alveolar IL-8 has been reported to early identify patients at-risk to develop ARDS. However, it remains unknown how alveolar IL-8 is related to pulmonary and systemic inflammation in patients predisposed for ARDS. We studied 24 patients 2-6h after multiple trauma. Patients with IL-8 >200 pg/ml in bronchoalveolar lavage (BAL) were assigned to the group at high risk for ARDS (H, n = 8) and patients with BAL IL-8 <200 pg/ml to the group at low risk for ARDS (L, n = 16). ARDS developed within 24h after trauma in 5 patients at high and at least after 1 week in 2 patients at low risk for ARDS (p = 0.003). High-risk patients had also increased BAL IL-6, TNF-α, IL-1β, IL-10 and IL-1ra levels (p<0.05). BAL neutrophil counts did not differ between patient groups (H vs. L, 12% (3-73%) vs. 6% (2-32%), p = 0.1) but correlated significantly with BAL IL-8, IL-6 and IL-1ra. High-risk patients had increased plasma levels of pro- but not anti-inflammatory mediators. The enhanced alveolar and systemic inflammation associated with alveolar IL-8 release should be considered to identify high-risk patients for pulmonary complications after multiple trauma to adjust surgical and other treatment strategies to the individual risk profile.
肺泡中的白细胞介素-8（IL-8）已被报道可以早期识别出有发生急性呼吸窘迫综合征（ARDS）风险的患者。然而，目前尚不清楚肺泡中的 IL-8 与易发生 ARDS 的患者的肺部和全身炎症之间有何关系。我们研究了 24 例多发伤后 2-6 小时的患者。支气管肺泡灌洗液（BAL）中 IL-8 ＞200pg/ml 的患者被分配到 ARDS 高危组（H 组，n=8），BAL IL-8＜200pg/ml 的患者被分配到 ARDS 低危组（L 组，n=16）。ARDS 在高危组的 5 例患者中在创伤后 24 小时内发展，在低危组的 2 例患者中至少在创伤后 1 周发展（p=0.003）。高危组患者 BAL 中白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、白细胞介素-10（IL-10）和白细胞介素-1受体拮抗剂（IL-1ra）水平也升高（p＜0.05）。两组患者 BAL 中性粒细胞计数无差异（H 组 vs. L 组，12%（3-73%）vs. 6%（2-32%），p=0.1），但与 BAL IL-8、IL-6 和 IL-1ra 呈显著相关。高危组患者的促炎介质而非抗炎介质的血浆水平升高。应考虑与肺泡中 IL-8 释放相关的增强的肺泡和全身炎症，以识别多发伤后发生肺部并发症的高危患者，根据个体风险特征调整手术和其他治疗策略。
