Comparison and significance of serum 7 cytokines in children with community-acquired common pneumonia and lobar pneumonia by Shi Changsong in Journal of Clinical Case Reports Medical Images and Health Sciences
Abstracts
Objective: To investigate the availability of seven serum cytokines, interleukin-4
(IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-17 (IL-17),
interleukin-12-70 (IL-12P70), tumor necrosis factor-α (TNF-α) and interferon-γ
(IFN-γ) changes and significance in Common and lobular community acquired
pneumonia (CAP).
Methods: Fifty-three patients admitted to our hospital from April 2022 to
July 2023 were selected as the observation group. According to the degree of
pneumonia, they were divided into common pneumonia group (observation
group 1), lobular pneumonia group (observation group 2), and children with
fever (acute upper respiratory tract infection) during the same period were
selected as the control group. The clinical data of the subjects in three groups
(observation group 1, 2 and control group) were retrospectively analyzed.
Temperature, length of stay, chest CT and other basic information were
recorded. Fasting venous blood of three groups of children was collected and
7 cytokines levels were detected. The cytokine levels of the three groups were
compared by one-way analysis of variance.
Results: The hospital stay of lobar pneumonia group was significantly longer
than that of common pneumonia group and fever group. There were no
significant differences in IL-4, IL-6,IL-10, IL-17, IL-12P70, TNF-a and IFN-γ among
lobular pneumonia group, common pneumonia group and fever group (P >
0.05).
Conclusion: Lobar pneumonia prolongs the hospital stay of children. The
cytokines IL-4,IL-6,IL-10,IFN-γ, IL-17,TNF-a and IL-12P70 showed no significant
difference in lobular pneumonia group, common pneumonia group and fever
group.
According to the World Health Organization, pneumonia killed 920,000
children under the age of five in 2016, 98% of whom were in developing
countries. Pneumonia is also one of the main causes of death among children
< 5 years old in China, and most of them are lobular community acquired
pneumonia (CAP)[1]. At present, there are few studies on biomarkers used
to assess disease severity and prognosis [2]. Cytokines are major regulatory
factors of inflammatory response, which play a role in amplifying, transducing
and coordinating pro-inflammatory signals, leading to synchronous expression
of molecular effectors and regulating autoimmune responses [3]. Previous
studies have shown that the prognostic value of changes in cytokine levels
is correlated with the severity of pneumonia [4]. The objective of this study
was to retrospectively analyze and compare cytokine levels in children with
common pneumonia and lobar pneumonia.
Data and methods
General Information:The medical records of 53 children with CAP who were hospitalized in the
pediatric respiratory department of our hospital from April 2022 to July 2023 were collected. According to the degree of pneumonia,
they were divided into common pneumonia group and
lobar pneumonia group. Children with fever during the
same period were selected as the control group, and basic
information such as temperature at admission, length of
stay, duration of medical history and chest CT were recorded.
Cytokine levels were determined by the key Laboratory of
hematological Pathology of our hospital. This study was
approved by the Ethics Committee of Henan Provincial
People's Hospital (2023) No. 65.
Inclusion and exclusion criteria for children with
pneumonia:
Inclusion criteria: 1) The diagnostic criteria of
community-acquired pneumonia and lobar pneumonia in
children in the 8th edition of Zhufutang Practical Pediatrics
were met; 2) Complete clinical data; Exclusion criteria: 1)
combined with other lung diseases, such as asthma and
tuberculosis; 2) Previous immune disease, unexplained
long-term fever, joint swelling and pain; 3) A recent or longterm history of glucocorticoid use; 4) Immunomodulators
and immunosuppressants such as immunoglobulin and
interferon have been applied in the past 2 months.
Statistical Processing:
All the data of the patients were recorded, and the
differences of each index between the two groups were analyzed using Graphpad Prism 8. Counting data is expressed
as example (%); The measurement data were expressed as
mean ± standard deviation (x±s), and the cytokine levels of
the three groups were examined by one-way ANOVA for
inter-group comparison. P < 0.05 was statistically significant.
Results: Compared with the other 2 groups, the length of
hospital stay in the lobar pneumonia group was significantly
increased, with statistical significance (P < 0.05), while there
was no statistical significance in other general data (P >
0.05).
Compared with lobular pneumonia group, common
pneumonia group and fever group, there were no significant
differences in serum cytokines in IL-4,IL-6,IL-10, IL-17, IL12P70, TNF-a and IFN-γ (P > 0.05).
Discussion:
CAP is a common infectious disease in childhood,
especially in infants and young children. It is the most
common cause of hospitalization in children and the first
cause of death in children under 5 years old. For hospitalized
children or areas with good conditions, the evaluation of CAP
severity should also be based on the scope of lung lesions,
the presence of hypoxemia, and the presence of internal
and external pulmonary complications[5]. This study was
mainly based on the clinical symptoms of pneumonia and
the range of chest imaging lesions as a grouping basis to determine the severity of pneumonia. The results of this
study found that the length of hospital stay in the fever
group, the common pneumonia group and the lobular
pneumonia group was different in pairwise comparison,
and the length of hospital stay in the lobular pneumonia
group was significantly longer than that in the other two
groups, indicating that the scope of chest imaging lesions
may affect the length of hospital stay and treatment time,
which has guiding significance for our clinical evaluation of
the length of hospital stay for pneumonia.
Cytokines, including types Th1 (IL-2, IFN-γ, TNF-α,
and IL-18) and Th2 (IL-4, IL-5, IL-6, IL-10, and IL-13), can
recruit or activate B, T, and NK cells to initiate and amplify
inflammatory/immune responses. Thus providing an
important function in host defense against bacterial or viral
infections [6]. Cytokines participate in the pathogenesis of
pneumonia by interacting with organ receptors [7], leading
to a decline in respiratory system related functions. Studies
have found that TNF-α, IFN-γ, IL-6, IL-8, IL-10, IL-1β and other
cytokines have been proven to be correlated with adult CAP
severity [8]. However, Luo Zhengxiu et al. retrospectively
analyzed and compared the serum cytokine levels between
the severe children group and the non-severe CAP group
and found no statistically significant differences in the levels
of IL-6, IL-2, IL-4, IL-10, TNF-α, IFN-γ and IL-17A between the
two groups [9]. Therefore, there is no consensus on the effect
of cytokines on the prognosis of childhood pneumonia. This
study found no correlation between IL-4, IL-6, IL-10, IFN-γ,
IL-17, TNF-α, and IL-12P70 and the severity of pneumonia.
Due to the single-center and small sample data in this study,
the correlation between these cytokines and the severity of
pneumonia needs further study.
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