Aliberti Stefano, Morlacchi Letizia Corinna, Faverio Paola, Fernandez-Botran Rafael, Cosentini Roberto, Mantero Marco, Peyrani Paula, Ramirez Julio, Bordon Jose, Blasi Francesco
Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
School of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, AO San Gerardo, Monza, Italy.
Pneumonia (Nathan). 2016 Jun 23;8:8. doi: 10.1186/s41479-016-0009-7. eCollection 2016.
The role and relationship between pro- and anti-inflammatory cytokines represents one of the least studied aspects of the pathogenesis of community-acquired pneumonia (CAP). The aim of the present study was to evaluate pro- and anti-inflammatory cytokines at both local (lung) and systemic (blood) levels and their relationship with the severity of the disease on admission and time for a patient to reach clinical stability during hospitalisation.
This was an observational, prospective, cohort study of hospitalised patients with a diagnosis of CAP at the IRCCS Policlinico Hospital, Milan, Italy, between April 2010 and January 2012. Ten pro-inflammatory cytokines (interleukin [IL]-1, IL-1α, IL-1β, IL-2, IL-6, IL-8, tumor necrosis factor [TNF]α and interferon [IFN]γ) and anti-inflammatory cytokines (IL-4 and IL-10) were measured in both serum and exhaled breath condensate within 24 h after hospital admission.
A total of 74 patients (median age: 76 years; gender: 61 % male) were enrolled. The anti- to pro-inflammatory cytokine ratio was reduced in patients with severe disease on admission and prolonged time to reach clinical stability. This was due to lower levels of anti-inflammatory cytokines in the exhaled breath condensate and higher levels of pro-inflammatory cytokines in serum.
Dis-regulation between pro- and anti-inflammatory pathways might be a part of the pathogenic mechanisms that lead to severe infection and worse early clinical outcomes in CAP patients.
促炎细胞因子和抗炎细胞因子之间的作用及关系是社区获得性肺炎（CAP）发病机制中研究最少的方面之一。本研究的目的是评估局部（肺部）和全身（血液）水平的促炎和抗炎细胞因子，以及它们与患者入院时疾病严重程度和住院期间达到临床稳定所需时间的关系。
这是一项对2010年4月至2012年1月期间在意大利米兰IRCCS综合医院住院的诊断为CAP的患者进行的观察性、前瞻性队列研究。在入院后24小时内，对血清和呼出气冷凝物中的十种促炎细胞因子（白细胞介素[IL]-1、IL-1α、IL-1β、IL-2、IL-6、IL-8、肿瘤坏死因子[TNF]α和干扰素[IFN]γ）和抗炎细胞因子（IL-4和IL-10）进行检测。
共纳入74例患者（中位年龄：76岁；性别：61%为男性）。入院时病情严重且达到临床稳定所需时间延长的患者，其抗炎与促炎细胞因子的比例降低。这是由于呼出气冷凝物中抗炎细胞因子水平较低，而血清中促炎细胞因子水平较高。
促炎和抗炎途径之间的失调可能是导致CAP患者发生严重感染和早期临床结局较差的致病机制的一部分。
