Puren A J, Feldman C, Savage N, Becker P J, Smith C
Department of Medical Biochemistry, University of the Witwatersrand Medical School, South Africa.
Chest. 1995 May;107(5):1342-9. doi: 10.1378/chest.107.5.1342.
Pneumonia continues to be a major cause of disease and death among patients worldwide. Aspects of the host response to infection, such as the release of cytokines, may be contributing to the persistent morbidity and mortality.
Plasma levels of cytokines interleukin (IL)-1 beta, IL-6, and tumor necrosis factor alpha (TNF-alpha) were measured in critically ill patients with pneumonia (ICUP; n = 12) and less severely ill patients with pneumonia (NONICUP; n = 8), and in 2 additional control groups of patients, viz, severely ill postoperative patients without evidence of infection (POSTOP; n = 11) and less severely ill patients with nonpneumonia infections (NONP; n = 9). All four groups of patients were studied in a multivariate one-way analysis of variance using the parameter vector: plasma IL-1 beta, IL-6, TNF-alpha, systolic blood pressure, diastolic blood pressure, plasma urea, creatinine, and temperature. Thereafter the significance of individual parameters were assessed by univariate analysis and pairwise comparisons.
All cytokine concentrations were highest in the ICUP group. In the case of IL-1 beta, levels were significantly higher in the ICUP group when compared with the noninfected POSTOP group. The acute physiology and chronic health evaluation (APACHE) II scores were identical in these two groups (17 +/- 3 [SD] and 10 +/- 1, respectively, not significantly different). Intermediate levels were found in those groups with intermediate levels of infection. The IL-6 levels were not significantly different between the groups and in particular, the levels in the ICUP and POSTOP groups were similar. The TNF-alpha levels tended to mimic those of IL-1 beta, although the significant difference found was between the ICUP and NONICUP groups which had significantly different APACHE II scores (17 +/- 3 vs 4.4 +/- 1, respectively). No association between cytokine levels and patient mortality was demonstrated.
Among the cytokines, IL-1 beta appeared to be associated with the severity of infection, IL-6 appears to reflect severity of stress whether of infection or noninfective origin, and TNF-alpha may be a marker of severity of pneumonia.
肺炎仍然是全球患者疾病和死亡的主要原因。宿主对感染的反应，如细胞因子的释放，可能导致持续的发病率和死亡率。
在重症肺炎患者（ICUP；n = 12）、病情较轻的肺炎患者（NONICUP；n = 8）以及另外两个对照组患者中测量血浆细胞因子白细胞介素（IL）-1β、IL-6和肿瘤坏死因子α（TNF-α），这两个对照组分别是无感染证据的重症术后患者（POSTOP；n = 11）和病情较轻的非肺炎感染患者（NONP；n = 9）。使用参数向量对所有四组患者进行多变量单因素方差分析：血浆IL-1β、IL-6、TNF-α、收缩压、舒张压、血浆尿素、肌酐和体温。此后，通过单因素分析和两两比较评估各个参数的显著性。
所有细胞因子浓度在ICUP组中最高。就IL-1β而言，与未感染的POSTOP组相比，ICUP组中的水平显著更高。这两组的急性生理和慢性健康评估（APACHE）II评分相同（分别为17±3[标准差]和10±1，无显著差异）。在感染程度中等的组中发现了中等水平。各组之间的IL-6水平无显著差异，特别是ICUP组和POSTOP组的水平相似。TNF-α水平倾向于模仿IL-1β的水平，尽管发现的显著差异存在于APACHE II评分显著不同的ICUP组和NONICUP组之间（分别为17±3和4.4±1）。未证明细胞因子水平与患者死亡率之间存在关联。
在细胞因子中，IL-1β似乎与感染的严重程度相关，IL-6似乎反映了应激的严重程度，无论其来源是感染性还是非感染性，而TNF-α可能是肺炎严重程度的标志物。
