Etiology and cytokine expression in patients requiring mechanical ventilation due to severe community-acquired pneumonia
Etiology and cytokine expression in patients requiring mechanical ventilation due to severe community-acquired pneumonia
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DOI：
10.1016/s0929-6646(09)60108-x
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发表时间：
2006-01-01
影响因子：
3.2
通讯作者：
Hsu, JY
中科院分区：
文献类型：
--
作者：
Wu, CL;Chan, MC;Hsu, JY
背景资料：对初始经验性治疗无反应的严重社区获得性肺炎（CAP）患者的细菌病原学和血清细胞因子水平之间的关系尚不清楚。本研究调查了细菌病原学、结果、支气管肺泡和全身细胞因子（白细胞介素[IL]-1 β、IL-8、IL-10）。方法：这项以医院为基础的研究纳入了2000年7月1日至2001年10月31日期间因严重CAP而对初始经验性治疗无反应并需要机械通气的47例连续患者，在台湾中部一家拥有1200张病床的教学医院的呼吸重症监护病房。住院后3天内进行支气管肺泡灌洗（BAL）。处理BAL液进行定量细菌培养。结果：最常见的病原体是铜绿假单胞菌（22.5%）和肺炎克雷伯菌（25%）。患者有K。肺炎分离株（n = 10）在BAL液中具有显著更高的IL-1 β水平，并且在血清和BAL液中具有显著更高的IL-10水平。非存活者的血清IL-8（p = 0.001）、血清IL-10（p < 0.001）和BAL IL-10（p = 0.039）水平高于存活者。在快速致死病例中，局部和全身细胞因子（IL-8和IL-10）的表达显著增加。在台湾，肺炎是需要机械通气的CAP的最常见原因。克雷伯氏菌引起的严重CAP患者的BAL液和血清中的细胞因子模式。与其他病原体相比，肺炎克雷伯氏菌显示出显著升高。支气管肺泡和全身细胞因子水平（特别是IL-10）预测死亡率。这些发现表明需要进行临床试验，以确定免疫调节治疗如何影响细胞因子谱和临床结果。
Background: The relationship between bacterial etiology and serum cytokine levels in patients with severe community-acquired pneumonia (CAP) without response to initial empiric treatment remains unclear. This study investigated the bacterial etiology, outcomes, and bronchoalveolar and systemic cytokines (interleukin [IL]-1 beta, IL-8, IL-10) in these patients.Methods: This hospital-based study enrolled 47 consecutive patients without response to initial empiric treatment and requiring mechanical ventilation due to severe CAP between July 1, 2000 and October 31, 2001, in a respiratory intensive care unit of a 1200-bed teaching hospital in central Taiwan. Bronchoalveolar lavage (BAL) was performed within 3 days after hospitalization. BAL fluid was processed for quantitative bacterial cultures. Blood samples were taken just before BAL, and the levels of both BAL and serum cytokines were measured.Results: The most common pathogens isolated were Pseudomonas aeruginosa (22.5%) and Klebsiella pneumoniae (25%). Patients with a K. pneumoniae isolate (n = 10) had significantly higher levels of IL-1 beta in BAL fluid and significantly higher levels of IL-10 in serum and BAL fluid than patients with other etiologies. Non-survivors had higher levels of serum IL-8 (p = 0.001), serum IL-10 (p < 0.001) and BAL IL-10 (p = 0.039) than survivors. Marked increases in local and systemic cytokine expression (IL-8 and IL-10) were noted in rapidly fatal cases.Conclusion: P. aeruginosa and K. pneumoniae are the most common causes of CAP requiring mechanical ventilation in Taiwan. Cytokine patterns in the BAL fluid and serum of patients with severe CAP due to K. pneumoniae showed significant elevations compared to other pathogens. Bronchoalveolar and systemic cytokine levels (especially IL-10) predicted mortality. These findings suggest the need for a clinical trial to determine how immunomodulating therapy might affect cytokine profiles and clinical outcome.