Basic research on prevention of aspiration pneumonia in acute stroke patients

急性脑卒中患者发生吸入性肺炎的风险很高。本研究旨在探讨吸入性肺炎并发症与唾液分泌型免疫球蛋白A（sIgA）、白细胞介素6（IL-6）、表皮生长因子（EGF）及口腔细菌的关系。14例卒中患者（年龄：平均值±SD ; 79.5±9.0）被分为非肺炎组（6人）或肺炎组（8人）。在第5、7、9、11和13天在医院采集唾液样本三次（上午10点、上午14点和下午18点）。采用酶联免疫吸附试验（ELISA）和实时荧光定量PCR（real-time PCR）检测标本，并对两组进行比较。结果，肺炎组唾液sIgA（sIgA浓度×唾液体积）显著增加（ANOVA ; p<0.01）。IL-6、EGF浓度各组间差异无统计学意义，EGF浓度与sIgA水平呈正相关（rs=0.574~0.900）。非肺炎组中有2人出现肺炎链球菌感染。肺炎组给予抗生素治疗。6人显示肺炎链球菌和缓症链球菌减少，4人显示铜绿假单胞菌增加。

Acute stroke patients have a high risk of aspiration pneumonia. The purpose of this study was to examine the relationship among complication of aspiration pneumonia and salivary secretory immunoglobulin A (sIgA), interleukin 6 (IL-6), epidermal growth factor (EGF), and oral bacteria. Fourteen stroke patients (Age : mean±SD ; 79.5±9.0) were classified into a non-pneumonia group (6 people) or a pneumonia group (8 people). Saliva samples were collected three times (10am, 14am, and 18 pm) on days 5, 7, 9, 11 and 13 in the hospital. Samples were measured by enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (real-time PCR), then compared between the two groups. As a result, there was a significant increase in the salivary sIgA (concentration of sIgA × saliva volume) in the pneumonia group (ANOVA ; p<0.01). The IL-6 and EGF concentrations did not significantly differ between groups, whereas the concentration of EGF correlated with the sIgA level (rs=0.574～0.900). Two people in the non-pneumonia group evidenced in Streptococcus pneumoniae. The pneumonia group people were given antibiotics. Six people showed less Streptococcus pneumoniae and Streptococcus mitis, and 4 people demonstrated increased Pseudomonas aeruginosa.