Kapanadze N, Pantsulaia I, Chkhaidze I
Vl. Bakhutashvili Institute of Medical Biotechnology, Tbilisi State Medical University; M. Iashvili Central Children Hospital, Tbilisi; G. Zhvania Pediatric Clinic. Tbilisi, Georgia.
Georgian Med News. 2018 Nov(284):103-108.
Community-acquired pneumonia is (CAP) associated with serious complications and is the leading cause of death in children. Severity of CAP is depend on an impairment of host defenses. Persistent and toxic inflammation directs to an excessively pro-inflammatory cytokine production, neutrophil hyper-responsiveness, and dysregulation of lung neutrophil apoptosis, which results in lung injury and poor patient outcomes. However, the correlation between increased cytokine levels and clinical outcome in children remains unclear. The main aim of present work was evaluation the potential association serum cytokine levels with complications and severity of pneumonia and identification marker for earlier diagnosis of pneumonia complications. For this purposes, 62 children admitted to Iashvili Central Children Hospital during 2013-2014, Tbilisi, Georgia, were investigated. The study was approved by the Ethics Committee of the Tbilisi State Medical University and written informed consent was obtained from the parents/legal guardians of all study participants. Control group consisted of 10 healthy age matched individuals. All samples (serum, urine, sputum, nasopharyngeal swabs) were analyzed for the presence of respiratory viruses and/or bacterial pathogens. The serum cytokines (IFN-gamma, TNF-alfa, IL-8, IL-10) levels were determined by enzyme-linked immunosorbent assay (ELISA) on the first and fifth day of hospitalization. The patients with community-acquired pneumonia on the first and fifth day of the treatment had significantly higher cytokine concentrations (IFN-g, TNF-a, IL-8, IL-10) than age matched individuals (p<0.01). Moreover, IL-10 and TNF-a (p<0.05) levels were statistical differ between groups with high and low saturation, However, patients with pleural effusion have significantly lower circulating IL- 8, than without effusion. Based on our results, circulatory cytokines (IL-10, TNF, IL-8) were elevated in CAP patient and can be used as markers of pneumonia severity signs (saturation, pleural effusion etc). However more studies are needed for before using cytokines as indicator of disease prognosis.
社区获得性肺炎（CAP）会引发严重并发症，是儿童死亡的主要原因。CAP的严重程度取决于宿主防御功能的损害。持续且有害的炎症会导致促炎细胞因子过度产生、中性粒细胞反应过度以及肺中性粒细胞凋亡失调，进而造成肺损伤并影响患者预后。然而，儿童细胞因子水平升高与临床结局之间的相关性仍不明确。本研究的主要目的是评估血清细胞因子水平与肺炎并发症及严重程度之间的潜在关联，并确定肺炎并发症早期诊断的标志物。为此，对2013年至2014年期间在格鲁吉亚第比利斯的伊阿什维利中央儿童医院住院的62名儿童进行了调查。该研究获得了第比利斯国立医科大学伦理委员会的批准，并获得了所有研究参与者父母/法定监护人的书面知情同意。对照组由10名年龄匹配的健康个体组成。对所有样本（血清、尿液、痰液、鼻咽拭子）进行呼吸道病毒和/或细菌病原体检测。在住院第一天和第五天通过酶联免疫吸附测定（ELISA）测定血清细胞因子（IFN-γ、TNF-α、IL-8、IL-IO）水平。治疗第一天和第五天的社区获得性肺炎患者的细胞因子浓度（IFN-γ、TNF-α、IL-8、IL-IO）显著高于年龄匹配个体（p<0.01）。此外，IL-10和TNF-α（p<0.05）水平在高饱和度组和低饱和度组之间存在统计学差异，然而，有胸腔积液的患者循环IL-8水平明显低于无胸腔积液的患者。根据我们的研究结果，CAP患者循环细胞因子（IL-10、TNF、IL-8）升高，可作为肺炎严重程度体征（饱和度、胸腔积液等）的标志物。然而，在将细胞因子用作疾病预后指标之前，还需要更多的研究。
