Compartmentalisation of cytokines and cytokine inhibitors in ventilator-associated pneumonia
Compartmentalisation of cytokines and cytokine inhibitors in ventilator-associated pneumonia
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DOI：
10.1007/s00134-003-2060-0
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发表时间：
2004-01-01
影响因子：
38.9
通讯作者：
Garrard, CS
中科院分区：
文献类型：
--
作者：
Millo, JL;Schultz, MJ;Garrard, CS
目的：检测呼吸机相关性肺炎（VAP）发生过程中肺室内细胞因子浓度是否发生变化。设计：在重症机械通气患者中每48小时进行一次非定向支气管灌洗（NBL）。通过ELISA对NBL液体和匹配血浆样本进行细胞因子肿瘤坏死因子（TNF）α、白细胞介素（IL）-1 α、IL-1 β、IL-6和IL-10以及细胞因子抑制剂可溶性TNF α受体I型（sTNFa RI）、IL-1受体拮抗剂（IL-1 Ra）和可溶性IL-1受体II（sIL-1 RII）的系列测量。单位：一所成人内科和外科大学医院重症监护室。患者：9例发生VAP的患者和19例未发生VAP的患者作为对照。干预措施：无。结果：在任何患者中，所测量的细胞因子和细胞因子抑制剂的血浆浓度均未发生显著变化。在对照组患者中，NBL液体中sIL-1 RII浓度随时间显著降低（P=0.01）。在发生VAP的患者中，NBL液体中TNF α、sTNFalphaRL、IL-1 α和IL-1 β的浓度显著升高（分别为P=0.002、P=0.03、P=0.04和P=0.02）。此外，随着VAP的发展，TNF α、sTNF α RI、IL-1 α、IL-1 Ra和IL-6的NBL液体/血浆浓度比显著增加（分别为P=0.001、P=0.001、P=0.04、P=0.03和P=0.04）。结论：我们的研究结果表明，在发生VAR的重症机械通气患者中，重要细胞因子和细胞因子抑制剂的产生在肺内是区室化的。
Objective: To examine whether cytokine concentrations change in the pulmonary compartment during the development of ventilator-associated pneumonia (VAP). Design: Non-directed bronchial lavage (NBL) was performed every 48 h in critically ill mechanically ventilated patients. Serial measurements of the cytokines tumor necrosis factor (TNF) alpha, interleukin (IL)-1alpha, IL-1beta, IL-6, and IL-10 and the cytokine inhibitors soluble TNFalpha receptor type I (sTNFalphaRI), IL-1 receptor antagonist (IL-1Ra) and soluble IL-1 receptor II (sIL-1RII) were performed on the NBL fluid and matching plasma samples by ELISA. Setting: An adult medical and surgical university hospital intensive care unit. Patients: Nine patients who developed VAP and nineteen patients who did not develop VAP served as controls. Interventions: None. Results: Plasma concentrations of the measured cytokines and cytokine inhibitors did not change significantly in any patients. In control patients, NBL fluid concentrations of sIL-1RII decreased significantly over time (P=0.01). In patients who developed VAP, NBL fluid concentrations of TNFalpha, sTNFalphaRL IL-1alpha, and IL-1beta increased significantly (P=0.002, P=0.03, P=0.04 and P=0.02, respectively). Furthermore, NBL fluid/plasma concentration ratios for TNFa, sTNFalphaRI, IL-1alpha, IL-1Ra and IL-6 increased significantly as VAP developed (P=0.001, P=0.001, P=0.04, P=0.03, and P=0.04, respectively). Conclusion: Our results suggest that the production of important cytokines and cytokine inhibitors is compartmentalised within the lung in critically ill mechanically ventilated patients who develop VAR