细胞因子与老年重症肺部感染病原菌的关系探讨  

The relationship between the levels of serum cytokines and pathogenic bacteria in the elderly with severe pneumonia

作　　者：姜晓晖[1] 孙仁华[1] 皇甫梅生[1] 

机构地区：[1]浙江省人民医院ICU室,杭州市310014

出　　处：《中华老年医学杂志》2005年第8期598-600,共3页Chinese Journal of Geriatrics

摘　　要：目的探讨细胞因子与老年人重症肺部感染病原菌的关系。方法对20例健康老年人、79例ICU感染早期、感染控制后的老年重症肺部感染患者空腹采血,酶联免疫吸附(ELISA)法测定样本的白细胞介素2受体(IL-2R)、白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)及C反应蛋白(CRP)的含量,并行冷凝集试验(CAT)排除支原体感染;同时细菌培养明确病原菌,评价细胞因子与老年重症肺部感染病原菌的关系。结果血清IL-2RI、L-6、CRP水平革兰阴性菌(G-)感染组、革兰阳性菌(G-)感染组、真菌感染组分别为较对照组均明显增高(P<0.01),差异有统计学意义;而感染组间比较差异无统计学意义(P>0.05)。G+感染组的血清IL-8水平明显低于G-感染组及真菌感染组(P<0.01),但与对照组比较,差异无统计学意义(P>0.05)。G+感染组血清TNF-α水平较对照组增高(P<0.05),但不如G-感染组、真菌感染组较对照组增高明显(P<0.01);G+感染组血清TNF-α水平与G-感染组、真菌感染组比较显著低下(P<0.05)。结论老年重症肺部G+感染者血清IL-2R、IL-6、CRP显著升高,而TNF-α升高较轻,IL-8降低,G-感染患者、真菌感染患者血清TNF-α、IL-2RI、L-6I、L-8、CRP均显著升高。老年肺部感染初期血清TNF-α、IL-8水平可以做为早期协助预测病原菌的指标。Objective To assess the relationship between the levels of serum cytokines and pathogenic bacteria in elderly patients with severe pneumonia. Methods Twenty normal old people and seventy nine aged people with severe pneumonia from intensive care unit were studied on pathogens, serum levels of interleukin-2R（IL-2R）, tumor necrosis factor-alpha（TNF-α）, interleukin-6（IL-6）, interleukin-8（IL-8）, C-reactive protein（CRP） and cold agglutination （CA）. Results Forty four of seventy nine cases （44/79）suffered from Gram-negative bacteria（GNB） , 21/79 Gram-positive bacteria（GPB）, 14/79 mycetes. The serum levels of IL-2R, IL-6, IL-8, TNF-α, CRP weresignificantly higher in the groups of GNB and mycetes infections （P〈0.01）. The serum levels of IL-2R,IL-6 ,CRP were significantly higher in GPB group （P〈0.01）, no statistic signigficance among groups of GPB and GNB and mycetes infections （P〉0.05）. The serum level of IL-8 in GPB group had no statistic difference compared with the control （P〉0.05） and was significantly lower than that in groups of GNB and mycetes＇ （P〈0.01）. The serum TNF-α level in GPB group was higher than that in the control but lower than that in GNB and mycetes＇ , （all P〈0.05）. Conclusions The serum levels of IL-2R, IL-6 and CRP are significantly higher in groups of GNB, GPB, and mycetes infections in aged cases with severe pneumonia. Serum IL-8 levels in GNB and mycetes cases are significantly higer than in the control, but lower or a little higher in GPB ones. Serum TNF-α in GPB cases is higher than control but lower than GNB and mycetes＇. TNF-α and IL-8 levels may be helpful in the prediction of the type of infection in the aged cases with severe pneoumonia and measurements of IL-2R,IL-6, CRP were not useful for identifying the type of infection in the aged cases with severe pneoumonia.

关 键 词：细胞因子 老年人 重症肺部感染 病原菌 酶联免疫吸附 

分 类 号：R563.1[医药卫生—呼吸系统]