重症肺炎患者气道内可溶性髓系细胞触发受体-1及TNF-α、IL-10水平的变化  

Changes of Airway sTREM-1,TNF-α,and IL-10 Levels in Patients with Severe Pneumonia

作　　者：曾勉[1] 唐朝霞[1] 何婉媚[1] 李悦[1] 

机构地区：[1]中山大学附属第一医院内科ICU/呼吸内科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2011年第1期60-66,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(7001634);广东省医学科研基金(A2004188)

摘　　要：【目的】观察重症肺炎患者诱导痰中可溶性髓系细胞触发受体-1(sTREM-1)及炎症介质水平变化,探讨重症肺炎气道局部炎症反应状态。【方法】对40例有创机械通气的重症肺炎患者和15例健康对照者进行高渗盐水的痰诱导,测定其诱导痰中sTREM-1、TNF-α、IL-10水平。并观察40例重症肺炎患者中存活组(18例)、死亡组(22例)入组第1、4、7天、出院或死亡当天诱导痰的sTREM-1、TNF-α、IL-10、TNF-α/IL-10水平变化趋势。【结果】重症肺炎患者入组后第1天诱导痰的sTREM-1、TNF-α、IL-10水平分别为(57±13、46±13、56±15)pg/mL,均高于正常对照组(16±5、19±3、16±6)pg/mL,(P<0.05)。随着时间延长存活组第1、4、7天、出院当天诱导痰的sTREM-1(52±18、46±14、44±10、38±8)pg/mL,TNF-α(52±18、46±14、44±10、38±8)pg/mL,IL-10(50±13、46±13、38±14、38±11)pg/mL的水平呈下降趋势;而死亡组第1、4、7天、死亡当天诱导痰的sTREM-1(62±16、67±18、64±18、71±17)pg/mL,TNF-α(50±12、49±15、59±16、58±16)pg/mL,IL-10(61±15、68±15、60±15、71±14)pg/mL水平均在较高水平波动,各观察点指标均高于存活组。重症肺炎患者各观察点诱导痰TNF-α/IL-10比值(分别为1.16±0.16;1.18±0.15;1.17±0.14;1.17±0.16)高于正常对照组(0.96±0.17)(P<0.05)。【结论】重症肺炎患者气道局部存在着过度炎症反应,促炎与抗炎介质失衡,尤以死亡组明显;sTREM-1在重症肺炎局部炎症反应中的可能起促炎作用。【Objective】 To observe the changes of sTREM-1 and inflammatory mediators in induced sputum of patients with severe pneumonia and explore the state of local inflammatory response in severe pneumonia.【Methods】 Forty mechanical ventilated severe pneumonia patients and fifteen healthy controls received hypertonic saline for sputum induction,the levels of soluble triggering receptor expressed on myeloid cell-1（sTREM-1）,tumor necrosis factor-α（TNF-α） and interleukin-10（IL-10） were determined by enzyme-linked immunosorbent assay（ELISA）.Changes of induced sputum sTREM-1,TNF-α,IL-10,and TNF-α/IL-10 levels were also observed in 40 severe pneumonia patients on the day of admission,day 4,7 and the day of discharge or death.Differences in the levels of these mediators were compared between 18 survivors and 22 non-survivors.【Results】 Induced sputum levels of sTREM-1,IL-10,and TNF-α [（57 ± 13,46 ± 13,56 ± 15） pg/mL,respectively] in patients with severe pneumonia were statistical significantly higher than the healthy controls [（16 ± 5,19 ± 3,16 ± 6） pg/mL,respectively] on the day of admission（P 0.05）.On the day of admission,day 4,7 and the day of discharge or death,induced sputum levels of sTREM-1 [（62 ± 16,67 ± 18,64 ± 18,71 ± 17） pg/mL,respectively],TNF-α [（50 ± 12,49 ± 15,59 ± 16,58 ± 16） pg/mL,respectively] and IL-10 [（61 ± 15,68 ± 15,60 ± 15,71 ± 14） pg/mL,respectively] were gradually decreased in survivors,while sTREM-1 levels [（62 ± 16,67 ± 18,64 ± 18 and 71 ± 17,respectively） pg/mL],TNF-α [（50 ± 12,49 ± 15,59 ± 16 and 58 ± 16,respectively） pg/mL] and IL-10 levels [（61 ± 15,68 ± 15,60 ± 15 and 71 ± 14,respectively） pg/mL] all fluctuated at a higher level in non-survivors.On different time points,the induced sputum levels of sTREM-1,IL-10,and TNF-α of non-survivors were all significantly higher than survivors（P 0.05）.The ratio of TNF-α to IL-10 was significantly higher in severe pneumonia group on different time point

关 键 词：重症肺炎 可溶性髓系细胞触发受体-1 炎症介质 诱导痰 

分 类 号：R563.1[医药卫生—呼吸系统]