血清可溶性细胞间黏附分子-1与重症肺炎的关系研究

Relationship between soluble intercellular adhesion molecule-1 and severe pneumonia

目的血清可溶性细胞间黏附分子-1(sICAM-1)是人体内重要的细胞表面黏附分子,参与机体众多的免疫反应及炎症反应,但其在重症肺炎患儿中的表达情况,以及与重症肺炎的关系,则未见系统的研究。该研究探讨血清sICAM-1在重症肺炎发病过程中的变化及其与重症肺炎的关系。方法采用双抗体夹心酶联免疫吸附法测定50例重症肺炎患儿和56例普通肺炎患儿不同病程中的血清sICAM-1水平,以及52例健康对照组小儿血清sICAM-1水平。结果重症肺炎急性期血清sICAM-1为402.36±31.24μg/L,明显高于其恢复期水平的198.56±12.63μg/L,差异具有显著性(P<0.01),与普通肺炎急性期的278.86±36.24μg/L及健康对照组180.74±21.46μg/L比较,差异亦有显著性(P<0.01);重症肺炎恢复期血清sICAM-1水平与普通肺炎恢复期的193.42±23.65μg/L及健康对照组比较,则差异无显著性(P>0.05);重症细菌性肺炎、病毒性肺炎、支原体(MP)肺炎、病毒与细菌混合感染性肺炎急性期血清sICAM-1分别为412.15±18.36μg/L、386.25±31.62μg/L、398.41±16.83μg/L、389.76±24.88μg/L,差异均无显著性(P>0.05);重症肺炎经治疗后痊愈病例及好转病例急性期血清sICAM-1分别为396.18±22.31μg/L,392.79±37.43μg/L,差异也无显著性(P>0.05)。结论sICAM-1可能参与了重症肺炎的炎症过程,其水平变化可以作为重症肺炎的诊断及病情轻重的判断指标之一。

Objective It has been reported that soluble intercellular adhesion molecule-1 （sICAM-1） participates in many immune and inflammatory reactions. Its expression and role in severe pneumonia has not fully been understood. This study aimed to investigate the changes of sICAM-1 expression in severe pneumonia and the relationship between sICAM-1 and severe pneumonia in children. Methods Serum sICAM-1 levels were determined by the double antibody sand using ELISA in 50 children with severe pneumonia and 56 children with mild pneumonia. Fifty-two healthy children served as control group. Results Serum sICAM-1 levels in children with severe pneumonia （402.36±31.24μg/L ） were remarkably higher than those in the mild pneumonia group （278.86±36.24μg/L） at the acute stage and higher than in the control group （180.74±21.46 μg/L） （ P 〈 0.01 ）. Serum sICAM-1 levels in children with severe pneumonia decreased significantly at the recovery stage （ 198.56±12.63μg/L） （ P 〈 0.01 ）, which were not statistically different from those in the mild pneumonia group at the recovery stage and the control group. There were no significant differences in serum sICAM-1 levels among the severe pneumonia subgroups caused by different pathogens （bacteria, virus or Mycoplasma） at the acute stage. Serum sICAM-1 levels at the acute stage in children with severe pneumonia who were treated successfully were not significantly different from those in patients whose symptoms were partly improved. Conclusions sICAM-1 might be involved in the inflammation course of severe pneumonia. It can severe as a marker of the diagnosis and the severity evaluation of severe pneumonia.