重症肺炎患者血清氧化应激指标和炎症因子的表达及其与肺部感染评分的关系
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摘要
目的:探讨重症肺炎患者血清氧化应激指标和炎症因子的表达及其与肺部感染评分(CPIS)的关系。方法:选取2016年1月到2018年12月在西安市胸科医院接受治疗的重症肺炎患者120例作为观察组,另选取同期在该院接受治疗的普通肺炎患者120例作为对照组。比较两组患者血清中的炎症因子指标、氧化应激指标和CPIS评分,分析重症肺炎患者炎症因子指标、氧化应激指标与CPIS评分的相关性。结果:观察组患者血清中白介素-6(IL-6)、白介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)水平明显高于对照组,差异具有统计学意义(P<0.05),观察组患者血清中过氧化脂质(LPO)水平高于对照组,血清中超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平低于对照组,差异具有统计学意义(P<0.05),观察组患者的CPIS评分高于对照组(P<0.05)。Pearson相关分析结果显示:重症肺炎患者的CPIS评分与IL-6、IL-18、TNF-α、LPO水平呈正相关(P<0.05),与SOD、GSH-Px水平呈负相关(P<0.05)。结论:重症肺炎患者存在明显的炎症反应和氧化应激反应,且炎症反应和氧化应激反应的程度和患者肺部感染程度密切相关。
Objective: To investigate the relationship between the expression of serum oxidative stress indexes and inflammatory factors in patients with severe pneumonia and their relationship with pulmonary infection score(CPIS). Methods: 120 patients with severe pneumonia who were treated in Xi'an Chest Hospital from October 2017 to September 2018 were selected as the observation group.Another 120 patients with common pneumonia who were treated in the hospital during the same period were selected as the control group. The inflammatory factors, oxidative stress indexes and CPIS score were compared between the two groups. The correlation between inflammatory factors and oxidative stress indexes and CPIS score in patients with severe pneumonia were analyzed. Results: The levels of serum interleukin-6(IL-6), interleukin-18(IL-18) and tumor necrosis factor-α(TNF-α) in the observation group were significantly higher than those in the control group, and the difference was statistically significant(P<0.05). The levels of serum lipid peroxidation(LPO) in the observation group was higher than that of the control group, the levels of serum superoxide dismutase(SOD) and glutathione peroxidase(GSH-Px) were lower than those of the control group, and the difference was statistically significant(P<0.05). The CPIS score of the observation group was higher than that of the control group(P<0.05). The results of Pearson correlation analysis show that the CPIS scores in patients with severe pneumonia was positively correlated with the levels of IL-6, IL-18, TNF-α and LPO(P<0.05),which was negatively correlated with the levels of SOD and GSH-Px(P<0.05). Conclusion: Severe pneumonia patients have obvious inflammatory reaction and oxidative stress reaction,and the degree of inflammation and oxidative stress is closely related to the degree of pulmonary infection.
Objective: To investigate the relationship between the expression of serum oxidative stress indexes and inflammatory factors in patients with severe pneumonia and their relationship with pulmonary infection score(CPIS). Methods: 120 patients with severe pneumonia who were treated in Xi'an Chest Hospital from October 2017 to September 2018 were selected as the observation group.Another 120 patients with common pneumonia who were treated in the hospital during the same period were selected as the control group. The inflammatory factors, oxidative stress indexes and CPIS score were compared between the two groups. The correlation between inflammatory factors and oxidative stress indexes and CPIS score in patients with severe pneumonia were analyzed. Results: The levels of serum interleukin-6(IL-6), interleukin-18(IL-18) and tumor necrosis factor-α(TNF-α) in the observation group were significantly higher than those in the control group, and the difference was statistically significant(P<0.05). The levels of serum lipid peroxidation(LPO) in the observation group was higher than that of the control group, the levels of serum superoxide dismutase(SOD) and glutathione peroxidase(GSH-Px) were lower than those of the control group, and the difference was statistically significant(P<0.05). The CPIS score of the observation group was higher than that of the control group(P<0.05). The results of Pearson correlation analysis show that the CPIS scores in patients with severe pneumonia was positively correlated with the levels of IL-6, IL-18, TNF-α and LPO(P<0.05),which was negatively correlated with the levels of SOD and GSH-Px(P<0.05). Conclusion: Severe pneumonia patients have obvious inflammatory reaction and oxidative stress reaction,and the degree of inflammation and oxidative stress is closely related to the degree of pulmonary infection.
引文
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[29]杨小琼,李国平,王孝芸,等.氧化应激DNA损伤在重症肺炎中的作用研究[J].国际呼吸杂志,2016,36(17):1308-1313
[30]Trefler S,Rodríguez A,Martín-Loeches I,et al.Oxidative stress in immunocompetent patients with severe community-acquired pneumonia.A pilot study[J].Med Intensiva,2014,38(2):73-82
[2]Luo J,Yu H,Hu YH,et al.Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia:a retrospective cohort study[J].J Thorac Dis,2017,9(10):3979-3995
[3]贺丹,武涧松,曹留霞,等.头孢哌酮钠舒巴坦钠联合莫西沙星治疗老年重症肺炎的疗效研究[J].现代生物医学进展,2017,17(30):5874-5878
[4]张艺,谢雄.血小板计数对小儿肺炎炎症反应及病情严重程度的评价[J].国际儿科学杂志,2016,43(9):735-737
[5]Sun K,Yajjala VK,Bauer C,et al.Nox2-derived oxidative stress results in inefficacy of antibiotics against post-influenza S.aureus pneumonia[J].J Exp Med,2016,213(9):1851-1864
[6]陈凯立,张汉洪,邢金莉,等.血清PCT、IL-18及APACHEⅡ评分对老年重症肺炎患者预后的评估价值[J].解放军医学院学报,201738(6):519-523
[7]de Brito RC,Lucena-Silva N,Torres LC,et al.The balance between the serum levels of IL-6 and IL-10 cytokines discriminates mild and severe acute pneumonia[J].BMC Pulm Med,2016,16(1):170
[8]邓斌,冯霞,王定勇,等.动态监测重症肺炎患者血浆中TNF-α与IL-10和TGF-β水平变化研究[J].中华医院感染学杂志,2016,26(13):2942-2944
[9]王立民,张建,戈艳蕾,等.老年重症肺炎患者预后的影响因素分析[J].山东医药,2017,57(12):65-67
[10]钱进,马晓蓉,张振宁,等.老年肺炎患者血浆超氧化物歧化酶水平与肺炎严重程度的相关性分析[J].中华医院感染学杂志,201424(20):5070-5072
[11]冯炽光.肺表面活性物质对早产呼吸窘迫综合征患儿血清中氧化应激产物及水通道蛋白水平的影响[J].中国妇幼保健,2017,32(16):3836-3840
[12]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279
[13]李永华,施春波,厉为良,等.临床肺部感染评分和降钙素原与重症肺炎患者病情严重程度评分的相关性研究[J].临床内科杂志2016,33(5):323-325
[14]Li H,Chen X,Zhou SJ.Dauricine combined with clindamycin inhibits severe pneumonia co-infected by influenza virus H5N1 and Streptococcus pneumoniae in vitro and in vivo through NF-κB signaling pathway[J].J Pharmacol Sci,2018,137(1):12-19
[15]Peng H,Xiao J,Wan H,et al.Severe Gastric Mycormycosis Infection Followed by Cytomegalovirus Pneumonia in a Renal Transplant Recipient:A Case Report and Concise Review of the Literature[J].Transplant Proc,2019,51(2):556-560
[16]Garba MA,Umar LW,Akeredolu FD,et al.Severe necrotising pneumonia in a toddler:A rare presentation with dual bacterial aetiology[J].Niger Postgrad Med J,2019,26(1):65-68
[17]Hosakote YM,Brasier AR,Casola A,et al.Respiratory Syncytial Virus Infection Triggers Epithelial HMGB1 Release as a Damage-Associated Molecular Pattern Promoting a Monocytic Inflammatory Response[J].J Virol,2016,90(21):9618-9631
[18]Pirozzi C,Sturrock A,Weng HY,et al.Effect of naturally occurring ozone air pollution episodes on pulmonary oxidative stress and inflammation[J].Int J Environ Res Public Health,2015,12(5):5061-5075
[19]Torres A,Sibila O,Ferrer M,et al.Effect of corticosteroids on treatment failure among hospitalized patients with severecommunity-acquired pneumonia and high inflammatory response:a randomized clinical trial[J].JAMA,2015,313(7):677-686
[20]da Cunha LG Jr,Ferreira MF,de Moraes JA,et al.Effect of naturally occurring ozone air pollution episodes on pulmonary oxidative stress and inflammation[J].Med Microbiol Immunol,2015,204(6):673-680
[21]彭洁,安娜,马骏麒,等.乌司他丁联合抗感染治疗对急性重症肺炎患者全身炎症、氧化应激反应的影响[J].海南医学院学报,2017,23(16):2180-2183
[22]Payus AO,Rajah R,Febriany DC,et al.Pulmonary Embolism Masquerading as Severe Pneumonia:A Case Report[J].Open Access Maced J Med Sci,2019,7(3):396-399
[23]刘武胜,李如梅,宋志峰,等.重症肺炎患者肺泡灌洗液的炎症因子动态变化特点及临床意义[J].临床肺科杂志,2016,21(5):831-834
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[25]Ramanathan K,Svasti JK,Mac Laren G.Extracorporeal life support for immune reconstitution inflammatory syndrome in HIV patients with Pneumocystis jirovecii pneumonia[J].J Artif Organs,2018,21(3):371-373
[26]钱振华,李茜,马卫星,等.顺尔宁乌司他丁与米力农联合治疗对小儿重症肺炎的影响[J].浙江临床医学,2017,19(6):1089-1090
[27]Yanling Q,Xiaoning C,Fei B,et al.Inhibition of NLRP9b attenuates acute lung injury through suppressing inflammation,apoptosis and oxidative stress in murine and cell models[J].Biochem Biophys Res Commun,2018,503(2):436-443
[28]Cai L,Yi F,Dai Z,et al.Loss of caveolin-1 and adiponectin induces severe inflammatory lung injury following LPS challenge through excessive oxidative/nitrative stress[J].Am J Physiol Lung Cell Mol Physiol,2014,306(6):L566-L573
[29]杨小琼,李国平,王孝芸,等.氧化应激DNA损伤在重症肺炎中的作用研究[J].国际呼吸杂志,2016,36(17):1308-1313
[30]Trefler S,Rodríguez A,Martín-Loeches I,et al.Oxidative stress in immunocompetent patients with severe community-acquired pneumonia.A pilot study[J].Med Intensiva,2014,38(2):73-82