Department of Pediatrics, Nagoya University, Graduate School of Medicine, and Nagoya Ekisaikai Hospital, Nagoya, Japan.
Cytokine. 2011 Nov;56(2):180-7. doi: 10.1016/j.cyto.2011.07.016. Epub 2011 Sep 8.
The 2009 A(H1N1) influenza virus has caused a large outbreak, and resulted in major complications of severe pneumonia and acute encephalopathy in the pediatric population in Japan.
This study examined six patients with acute encephalopathy, 34 patients with severe pneumonia, five patients with both pneumonia and encephalopathy, and 46 patients without severe complications. The concentrations of 27 cytokines were examined in the cerebrospinal fluid of patients with encephalopathy, and the levels of these cytokines, Cytochrome c, high-mobility group box 1 (HMGB1) were measured in the serum of all patients.
Patients with severe pneumonia had higher serum concentrations of 16 cytokines, including Th1 cytokines, Th2 cytokines, chemokines, and growth factors, than patients with uncomplicated influenza. The distribution of 27 cytokines in the CSF did not parallel the serum levels in 11 patients with acute encephalopathy. HMGB1 concentrations in the serum were significantly higher in pneumonia patients with or without encephalopathy than in uncomplicated influenza patients, and were significantly associated with the upregulation of 10 cytokines.
Elevated levels of Th2 cytokines appear to be unique to influenza caused by 2009 H1N1 influenza virus and HMGB1 could play an important role in the pathogenesis of severe pneumonia. There appear to be different pathologic processes for encephalopathy and pneumonia.
2009 年甲型 H1N1 流感病毒引起了大爆发，导致日本儿科人群中出现严重肺炎和急性脑病等严重并发症。
本研究检查了 6 例急性脑病患者、34 例严重肺炎患者、5 例肺炎合并脑病患者和 46 例无严重并发症患者。检查了脑病患者脑脊液中的 27 种细胞因子浓度，并测量了所有患者血清中的细胞色素 c 和高迁移率族蛋白 B1（HMGB1）水平。
与单纯流感患者相比，严重肺炎患者血清中包括 Th1 细胞因子、Th2 细胞因子、趋化因子和生长因子在内的 16 种细胞因子浓度更高。11 例急性脑病患者脑脊液中 27 种细胞因子的分布与血清水平不一致。肺炎患者无论是否合并脑病，其血清中 HMGB1 浓度均明显高于单纯流感患者，且与 10 种细胞因子的上调显著相关。
高水平的 Th2 细胞因子似乎是 2009 年 H1N1 流感病毒引起的流感所特有的，HMGB1 可能在严重肺炎的发病机制中发挥重要作用。脑病和肺炎的发病机制似乎不同。
