Rendón-Ramirez Erick J, Ortiz-Stern Alejandro, Martinez-Mejia Corazon, Salinas-Carmona Mario C, Rendon Adrian, Mata-Tijerina Viviana L, Rosas-Taraco Adrian G
1Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.
2Department of Internal Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.
Viral Immunol. 2015 Jun;28(5):248-54. doi: 10.1089/vim.2014.0123. Epub 2015 Apr 29.
There is a strong interest in finding adequate biomarkers to aid in the diagnosis and prognosis of influenza A (H1N1)pdm09 virus infection. In this study, serum levels of inflammatory cytokines and laboratory markers were evaluated to assess their usefulness as biomarkers of influenza A (H1N1)pdm09 and their association with fatal cases. Serum samples of consecutive patients with a clinical presentation suggestive of influenza A (H1N1)pdm09 and progression to sepsis were evaluated. Serum inflammatory cytokines and routine laboratory tests were performed and correlated with positivity for influenza A (H1N1)pdm09 influenza by real time reverse transcription polymerase chain reaction and the results of three clinical severity scores (Sequential Organ Failure Assessment [SOFA], CURB-65, and Acute Physiology and Chronic Health Evaluation II [APACHE II]). High SOFA scores and some of its individual components, but not CURB-65 or APACHE II scores, correlate with fatal cases regardless of etiology. Total and unconjugated bilirubin, Ca(++), Cl(-), prothrombin times, and partial thromboplastin times discriminate influenza A (H1N1)pdm09 from other causes of community-acquired pneumonia. High levels of IL-8, IL-10, and IL-17 were increased in influenza A (H1N1)pdm09 patients when compared with controls (p<0.05). IL-6 levels were significantly elevated in influenza A (H1N1)pdm09 patients and non-(H1N1)pdm09 patients when compared with controls (p<0.05). TGF-β serum levels discern between healthy controls, influenza A (H1N1)pdm09 patients, and patients with other causes of community-acquired pneumonia. TGF-β levels were negatively correlated with SOFA on admission in influenza A (H1N1)pdm09 patients. TGF-β levels are a useful tool for differentiating influenza A (H1N1)pdm09 from other causes of pneumonia progressing to sepsis.
人们对寻找合适的生物标志物以辅助甲型H1N1流感病毒感染的诊断和预后评估有着浓厚兴趣。在本研究中，对血清炎症细胞因子水平和实验室指标进行了评估，以确定它们作为甲型H1N1流感生物标志物的效用及其与致命病例的关联。对临床表现提示甲型H1N1流感且病情进展为脓毒症的连续患者的血清样本进行了评估。进行了血清炎症细胞因子检测和常规实验室检查，并将其与实时逆转录聚合酶链反应检测的甲型H1N1流感阳性结果以及三个临床严重程度评分（序贯器官衰竭评估[SOFA]、CURB-65和急性生理与慢性健康状况评估II[APACHE II]）的结果进行关联分析。无论病因如何，高SOFA评分及其一些个别组成部分与致命病例相关，但CURB-65或APACHE II评分与致命病例无关。总胆红素和非结合胆红素、Ca(++)、Cl(-)、凝血酶原时间和部分凝血活酶时间可将甲型H1N1流感与社区获得性肺炎的其他病因区分开来。与对照组相比，甲型H1N1流感患者中IL-8、IL-10和IL-17水平升高（p<0.05）。与对照组相比，甲型H1N1流感患者和非甲型H1N1流感患者的IL-6水平均显著升高（p<0.05）。转化生长因子-β（TGF-β）血清水平可区分健康对照组、甲型H1N1流感患者和社区获得性肺炎其他病因的患者。在甲型H1N1流感患者中，入院时TGF-β水平与SOFA呈负相关。TGF-β水平是区分甲型H1N1流感与进展为脓毒症的其他肺炎病因的有用工具。
