Hu Chao, Peng Li, Liu Kang, Yang Li, Zhang Ying, Deng Hui, Li Hui, Jiang Ming Yan
Department of Pulmonary and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, China.
Department of Oncology, Xiangtan Central Hospital, Xiangtan, Hunan, China.
Front Cell Infect Microbiol. 2025 Jun 30;15:1480123. doi: 10.3389/fcimb.2025.1480123. eCollection 2025.
Prone positioning is a commonly recommended intervention in clinical practice to enhance oxygenation in COVID-19 patients with ARDS, but its effects on inflammatory markers in the blood and lungs have not been thoroughly investigated.
This retrospective study examined COVID-19-related ARDS patients admitted to the ICU of a tertiary hospital between January 2020 and November 2023. The analysis focused on measuring cytokines and lymphocyte subsets in both blood and bronchoalveolar lavage fluid (BALF) to evaluate the impact of prone positioning on inflammatory markers in the lungs and systemic circulation.
Of the 86 intubated patients, 44 were included in the study, with 30 undergoing prone positioning. Compared to the supine position, prone positioning was associated with elevated plasma levels of IL-12p70 and IL-4, as well as increased expression of IFN-α and TNF-α in BALF. With increased frequency of prone positioning, oxygenation progressively improved, accompanied by a rise in plasma IL-4 levels. No significant differences in peripheral blood lymphocyte levels were observed between the supine and prone groups.
This study sheds light on the potential mechanisms of prone positioning in both local and systemic circulation, particularly in the context of inflammatory markers. In COVID-19-related ARDS, prone positioning may strengthen the immune response by modulating inflammatory markers in the lungs and bloodstream.
俯卧位是临床实践中常用的一种干预措施，用于改善患有急性呼吸窘迫综合征（ARDS）的新冠肺炎患者的氧合，但它对血液和肺部炎症标志物的影响尚未得到充分研究。
这项回顾性研究考察了2020年1月至2023年11月期间入住一家三级医院重症监护病房（ICU）的新冠肺炎相关ARDS患者。分析重点在于测量血液和支气管肺泡灌洗液（BALF）中的细胞因子和淋巴细胞亚群，以评估俯卧位对肺部和全身循环中炎症标志物的影响。
在86例插管患者中，44例纳入研究，其中30例接受了俯卧位治疗。与仰卧位相比，俯卧位与血浆中IL-12p70和IL-4水平升高以及BALF中IFN-α和TNF-α表达增加有关。随着俯卧位频率增加，氧合逐渐改善，同时血浆IL-4水平上升。仰卧组和俯卧组外周血淋巴细胞水平无显著差异。
本研究揭示了俯卧位在局部和全身循环中的潜在机制，特别是在炎症标志物方面。在新冠肺炎相关ARDS中，俯卧位可能通过调节肺部和血液中的炎症标志物来增强免疫反应。
