| Objective To study the expression of serum Th1/Th2 related cytokines in patients with community acquired pneumonia(CAP)and the relationship of Th1/Th2 related cytokines concentration and the severity of the disease,through the retrospective analysis.And to find out the clinical value of serum Th1/Th2 related cytokines concentration in assessment of the severity and prognosis in patients with CAP.Methods A retrospective analysis was made to the 244 CAP patients admitted to the department of Respiratory and Critical Care Medicine and Respiratory Intensive Care Unit(RICU)of the First Affiliated Hospital of Zhengzhou University from June 2017 and November 2018.The patients were divided into the severe pneumonia(SP)group and the non-severe pneumonia(NSP)group according to the diagnostic criteria of severe CAP.Then the SP patients were divided into the improved(survival)SP group and the deteriorated(dead)SP group according to the outcomes at 7d.Analysis the general information(including gender,age and underlying diseases involving immunosuppression)and the outcomes at 7d.Acute physiology and chronic health evaluation(APACHE II)scores were made in SP patient at admissions.Investigate the expression of serum Th1/Th2 related cytokines(Th1 related cytokines,IL-2,TNF-α,IFN-γ and Th2 related cytokines,IL-4,IL-6,IL-10),procalcitonin(PCT)and Creactive protein(CRP)within 24 hours after admission.Then analysis the correlation between serum Th1/Th2 related cytokines and APACHEⅡ score,PCT and CRP.Analysis the risk factors of the prognosis of SP patients.Results 1.Patients in SP group were older than NSP ones(the SP group 64±16y,the NSP group 58±13y,P<0.05).Patients with underlying diseases involving immunosuppression(including autoimmune diseases,chronic renal failure /hemodialysis,end-stage liver disease,malignancies,transplantation and diabetes mellitus)in SP group were more than NSP ones(P<0.05).Patients in deteriorated SP group were older than improved SP ones(the deteriorated SP group 71±12y,the improved SP group 57±18y,P<0.05).Additionally,compared to the improved SP group,the deteriorated SP group showed more severe condition,higher APACHE II score(deteriorated SP group 22.93±6.92,improved SP group 14.71±4.47,P<0.05).2.Compared to the NSP group,the SP group showed higher concentrations of serum Th2 related cytokines(IL-6,IL-10)(SP IL-6,601.98±164.03pg/m L,NSP IL-6,16.14±5.18 pg/m L,P<0.05 and SP IL-10,38.69±24.90 pg/m L,NSP IL-10,5.73±2.41 pg/m L,P<0.05).The SP group showed higher concentrations of serum PCT and CRP(SP PCT,7.35±4.28 ng/m L,NSP PCT,1.87±0.98 ng/m L,P<0.05 and SP CRP,93.56±33.59 mg/L,NSP CRP,50.27±27.49 mg/L,P<0.05).There were no significant differences in the concentrations of serum Th1 related cytokines between the two groups(P>0.05).Compared to the improved SP group,the deteriorated SP group showed higher concentrations of serum Th2 related cytokines(IL-6,IL-10)(deteriorated SP group IL-6,1105.09±299.48 pg/m L,improved SP group IL-6,29.83±9.06 pg/m L,P<0.05 and deteriorated SP group IL-10,67.73±26.06 pg/m L,improved SP group IL-10,5.65±1.74 pg/m L,P<0.05).The SP group showed higher concentrations of serum PCT and CRP(deteriorated SP group PCT,12.39±6.22 ng/m L,improved SP group PCT,1.61±0.92 ng/m L,P<0.05 and deteriorated SP group CRP,101.17±33.76 mg/L,improved SP group CRP,84.90±43.78 mg/L,P<0.05).There were no significant differences in the concentrations of serum Th1 related cytokines between the two groups(P>0.05).3.The Pearson correlation analysis showed the positive correlations between IL-6 and PCT,CRP and APACHE II score(the correlation coefficients sequentially were 0.374,0.323 and 0.494,P<0.05).There were the positive correlations between IL-10 and PCT,CRP and APACHE II score(the correlation coefficients sequentially were 0.440 and 0.344,P<0.05).There were the positive correlations between IL-4 and PCT(the correlation coefficients were 0.182 and 0.224,P<0.05).4.In NSP group and SP group,the ROC curve analysis showed the area under the curve(AUC)of serum concentrations of IL-6,IL-10,PCT,and CRP sequentially were 0.785,0.674,0.69 and 0.708,and sensitivity were 72.5%,56%,76.1% and 79.8% respectively,and specificity were 75.6%,77.8%,62.2% and 57.8% respectively.The cut-off points were 16.6pg/m L,5.6pg/m L,0.17 ng/m L and 27.2 mg/L respectively.In the deteriorated SP group and improved SP group,the ROC curve analysis showed the AUC of serum concentrations of IL-6,IL-10 and PCT sequentially were 0.854,0.746 and 0.666,and sensitivity were 75.9%,65.5% and 69% respectively,and specificity were 80.4%,88.2% and 60.8% respectively.The cut-off points were 42.54pg/m L,6.65pg/m L and 0.31 ng/m L respectively.5.Multivariate logistic regression analysis indicated that serum concentrations of IL-6,IL-10 and APACHE II score within 24 hours after admission were independent risk factors of deteriorated SP patients,with odds ratios of 2.05,1.35 and 1.36(95% CI: 1.87-2.28,1.14-1.62 and 1.19-1.57,P <0.05)respectively.Conclusion 1.The expressions of serum Th2 cytokines IL-6 and IL-10 in SP group were significantly higher than those in NSP group,and detecting the expression of them may help to assess the severity of CAP.2.Serum levels of Th2 cytokines IL-6 and IL-10 were significantly higher in SP deterioration group than those in the improvement group,and they were independent risk factors affecting the prognosis of SP patients.Detection of serum levels of them may assist to evaluate the prognosis of SP patients. |
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