社区获得性肺炎不同病因患者细胞因子/趋化因子的演变。

Evolution of cytokines/chemokines in cases with community-acquired pneumonia and distinct etiologies.

机构信息

Bahiana School of Medicine and Public Health, Bahiana Foundation for Science Development, Salvador, Brazil.

Instituto Gonçalo Moniz, Fundação Oswaldo Cruz-Fiocruz, Salvador, Brazil.

出版信息

Pediatr Pulmonol. 2020 Jan;55(1):169-176. doi: 10.1002/ppul.24533. Epub 2019 Sep 25.

DOI:10.1002/ppul.24533

PMID:31553527

Abstract

AIM

To compare the systemic cytokines/chemokines levels over time during the evolution of children hospitalized with community-acquired pneumonia (CAP) with and without pneumococcal infection.

METHODS

Children less than 5-years-old hospitalized with CAP were prospectively investigated in Salvador, Brazil. Clinical data and biological samples were collected to investigate 20 etiological agents and to determine serum cytokines/chemokines levels on admission and 2 to 4 weeks later. Cases with pneumococcal infection received this diagnosis irrespective of also having other etiologies.

RESULTS

A total of 277 patients were enrolled, however, serum sample was unavailable for cytokine measurement upon admission (n = 61) or upon follow-up visit (n = 36), etiology was undetected (n = 50) and one patient did not attend the follow-up visit. Therefore, this study group comprised of 129 cases with established etiology. The median (interquartile range) age and sampling interval was 18 (9-27) months and 18 (16-21) days, respectively. Established etiology was viral (52.0%), viral-bacterial (30.2%), and bacterial (17.8%). Pneumococcal infection was found in 31 (24.0%) patients. Overall, median interleukin-6 (IL-6; 10.6 [4.7-30.6] vs 21.0 [20.2-21.7]; P = .03), IL-10 (3.5 [3.1-4.5] vs 20.1 [19.8-20.4]; P < .001), and CCL2 (19.3 [12.4-23.2] vs 94.0 [67.2-117.8]; P < .001) were significantly higher in convalescent serum samples, whereas median CXCL10 (83.6 [36.4-182.9] vs 14.6 [0-116.6]; P < .001) was lower. Acute vs convalescent levels evolution of IL-10, CCL2, and CXCL10 did not differ among patients with or without pneumococcal infection. However, IL-6 decreased (27.8 [12.3-48.6] vs 20.8 [20.2-22.6]; P = .1) in patients with pneumococcal infection and increased (9.0 [4.2-22.6] vs 21.0 [20.2-21.7]; P = .001) in patients without it.

CONCLUSION

The marked increase of IL-6 serum levels during the acute phase makes it a potential biomarker of pneumococcal infection among children with CAP.

摘要

目的

比较伴有和不伴有肺炎链球菌感染的社区获得性肺炎（CAP）住院患儿在病程中系统性细胞因子/趋化因子水平的变化。

方法

本前瞻性研究在巴西萨尔瓦多对小于 5 岁因 CAP 住院的患儿进行调查。采集临床数据和生物样本，以调查 20 种病因，并在入院时和 2 至 4 周后测定血清细胞因子/趋化因子水平。有肺炎链球菌感染的病例不论是否同时存在其他病因，均做出此诊断。

结果

共纳入 277 例患儿，然而，入院时（n=61）或随访时（n=36）细胞因子检测的血清样本不可用，病因未检出（n=50），1 例患儿未参加随访。因此，本研究组纳入了 129 例病因明确的病例。中位（四分位距）年龄和采样间隔分别为 18（9-27）个月和 18（16-21）天。明确的病因是病毒（52.0%）、病毒-细菌（30.2%）和细菌（17.8%）。31 例（24.0%）患儿有肺炎链球菌感染。总体而言，入院时，白细胞介素 6（IL-6；10.6[4.7-30.6] vs 21.0[20.2-21.7]；P=0.03）、IL-10（3.5[3.1-4.5] vs 20.1[19.8-20.4]；P<0.001）和 CCL2（19.3[12.4-23.2] vs 94.0[67.2-117.8]；P<0.001）明显更高，而 CXCL10 中位水平（83.6[36.4-182.9] vs 14.6[0-116.6]；P<0.001）更低。有或没有肺炎链球菌感染的患儿的急性 vs 恢复期的 IL-10、CCL2 和 CXCL10 水平演变没有差异。然而，肺炎链球菌感染患儿的 IL-6 下降（27.8[12.3-48.6] vs 20.8[20.2-22.6]；P=0.1），而无肺炎链球菌感染患儿的 IL-6 升高（9.0[4.2-22.6] vs 21.0[20.2-21.7]；P=0.001）。