血漿單核細胞趨化蛋白-1可作為社區型肺炎嚴重度的預測因子

Plasma monocyte chemoattractant protein-1 level as a predictor of the severity of community-acquired pneumonia

楊國坤(Kok-Khun Yong)

指導教授 ： 曹昌堯 ； 楊順發

中山醫學大學/醫學院/醫學研究所/博士(2017年)

摘要

研究背景：單核細胞趨化蛋白（Monocyte chemoattractant protein; MCP）-1在血清中的大量表現被發現與免疫治療社區性肺炎（community-acquired pneumonia; CAP）有關。然而，MCP-1在CAP患者血漿中的濃度及其嚴重程度的相關性仍不清楚。因此，本論文擬探討CAP患者其血漿中MCP-1的表現與使用抗生素治療前後的差別並進一步分析CAP嚴重性和MCP-1濃度之間的關聯。
研究方法：本論文利用酶聯免疫吸附法來分析137 位肺炎患者 和74名健康的血漿中MCP-1的濃度。在最初住院治療，急性生理和慢性健康評估II（APACHE II）;意識紊亂，尿素濃度，呼吸頻率，血壓，年齡>64年（CURB-65）;和肺炎的嚴重程度指數（PSI）的分數都被用來評估這些患者中的CAP的嚴重性。
研究結果：結果發現白血球細胞和嗜中性粒細胞的數量以及C-反應蛋白（CRP）和MCP-1的濃度在抗生素使用後都有明顯的下降。血漿中MCP-1的濃度與PSI（r = 0.509，p <0.001），CURB-65（r = 0.468，p <0.001），與APACHE II（r = 0.360，p <0.001）等CAP嚴重指數有明顯的相關性。
結論與建議：血漿MCP-1濃度可能在診斷及臨床治療社區性肺炎的患者嚴重性中扮演著一個角色，來作為發展治療及評估的準則。

關鍵字

社區性肺炎 ； 單核細胞趨化蛋白-1 ； 肺炎的嚴重程度指數 ； 生物指標

並列摘要

Background：Monocyte chemoattractant protein (MCP)-1 increases in the serum of immunocompetent patients with community-acquired pneumonia (CAP). However, the correlation between the circulating level of MCP-1 and severity of CAP remains unclear. This study investigated differential changes in the plasma MCP-1 levels of patients with CAP before and after an antibiotic treatment and further analyzes the association between the CAP severity and MCP-1 levels.
Methods：We measured the plasma MCP-1 levels of 137 patients with CAP and 74 healthy controls by using a commercial enzyme-linked immunosorbent assay. Upon initial hospitalization, Acute Physiology and Chronic Health Evaluation II (APACHE II); confusion, urea level, respiratory rate, blood pressure, and age of >64 years (CURB-65); and pneumonia severity index (PSI) scores were determined for assessing the CAP severity in these patients.
Results：The antibiotic treatment reduced the number of white blood cells (WBCs) and neutrophils as well as the level of C-reactive protein (CRP) and MCP-1. The plasma MCP-1 level, but not the CRP level or WBC count, correlated with the CAP severity according to the PSI (r = 0.509, p < 0.001), CURB-65 (r = 0.468, p < 0.001), and APACHE II (r = 0.360, p < 0.001) scores.
Conclusions：Plasma MCP-1 levels may play a role in the diagnosis and clinical assessment of CAP severity, which potentially guides the development of treatment strategies.

並列關鍵字

Community-acquired pneumonia ； Pneumonia severity index ； Monocyte chemoattractant protein-1 ； Biochemical marker

參考文獻

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56.Holub M, Lawrence DA, Andersen N, et al. 2013. Cytokines and chemokines as biomarker of community-acquired bacterial infection. Mediator of inflammation. 2013, 190145.

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