Inflammatory cytokines in patients with persistence of the acute respiratory distress syndrome
Inflammatory cytokines in patients with persistence of the acute respiratory distress syndrome
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DOI：
10.1164/ajrccm.154.3.8810593
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发表时间：
1996-09-01
影响因子：
24.7
通讯作者：
Martin, TR
中科院分区：
文献类型：
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作者：
Goodman, RB;Strieter, RM;Martin, TR
为了确定急性呼吸窘迫综合征 (ARDS) 患者空腔细胞因子和细胞炎症反应之间的关系，我们在 ARDS 发病后第 3、7、14 和/或 21 天对 82 名前瞻性鉴定的机械通气患者进行了支气管肺泡灌洗 (BAL)。我们研究了支气管肺泡灌洗液 (BALF) 细胞群与两种强效中性粒细胞 (PMN) 趋化剂：白细胞介素 8 (IL-8) 和上皮细胞源性中性粒细胞激活剂 78 (ENA-78) 浓度之间的关系；两种有效的单核细胞趋化剂，单核细胞趋化肽-1 (MCP-1) 和巨噬细胞炎症肽-1 α (MIP-1 α)；以及早期反应细胞因子白细胞介素 1 β (IL-1 β) 及其天然拮抗剂 IL-1 受体拮抗剂蛋白 (IRAP)。我们发现，无论 ARDS 持续时间长短，所有这些细胞因子均显着增加。 IL-8 和 ENA-78 是与 ARDS 患者肺液中 PMN 浓度相关性最强且一致的细胞因子，并且这种相关性独立于其他细胞因子或共存的肺部感染。所测试的细胞因子均与巨噬细胞浓度无关。 MCP-1 与第 7、14 和 21 天的肺损伤评分直接相关。虽然 IL-8 和 ENA-78 均与结果无关，但第 7 天测量的 IL-1 β 水平与死亡风险增加相关（比值比 [OR] = 2.8；95% 置信区间 [CI] = 1.1 至 7.4）。这些数据证明了 ARDS 患者肺部持续炎症过程的潜在分子机制。
To determine the relationship between airspace cytokines and cellular inflammatory responses in patients with the acute respiratory distress syndrome (ARDS), we performed bronchoalveolar lavage (BAL) in 82 prospectively identified, mechanically ventilated patients on Days 3, 7, 14, and/or 21 after the onset of ARDS. We studied the relationships between bronchoalveolar lavage fluid (BALF) cell populations and the concentrations of two potent neutrophil (PMN) chemoattractants, interleukin-8 (IL-8) and epithelial cell-derived neutrophil activator-78 (ENA-78); two potent monocyte chemoattractants, monocyte chemotactic peptide-1 (MCP-1) and macrophage inflammatory peptide-1 alpha (MIP-1 alpha); and the early response cytokine interleukin-1 beta (IL-1 beta) and its naturally occurring antagonist, IL-1 receptor antagonist protein (IRAP). We found that all of these cytokines were significantly increased regardless of the duration of ARDS. IL-8 and ENA-78 were the cytokines most strongly and consistently correlated with PMN concentrations in the lung fluids of patients with ARDS, and the correlations were independent of the other cytokines or coexisting lung infection. None of the cytokines tested correlated with macrophage concentrations. MCP-1 was directly correlated with lung injury score on Days 7, 14, and 21.Although neither IL-8 nor ENA-78 was associated with outcome, levels of IL-1 beta measured on Day 7 were associated with an increased risk of death (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.1 to 7.4). These data demonstrate potential molecular mechanisms of the persistent inflammatory process in the lungs of patients with ARDS.