重症肺炎患者Th17及Treg相关细胞因子的动态变化

The dynamic changes of Th17 and Treg related cytokines in patients with severe pneumonia

目的探讨重症社区获得性肺炎患者Th17及Treg相关细胞因子IL-17A、IL-10的动态变化及临床意义。方法选取2020年4月~2021年6月于惠州市中心人民医院住院的重症肺炎及同期轻症肺炎、健康体检者为研究对象,重症肺炎根据转归不同分为生存组和死亡组。检测所有研究对象入组当天及重症肺炎组第4~6天、9~11天血清IL-17A及IL-10水平并进行统计学分析。结果①重症肺炎患者促炎因子IL-17A水平明显高于轻症肺炎组及健康体检者(P<0.05),但抗炎因子IL-10水平差异不显著;②动态监测显示重症肺炎患者IL-17A水平总体呈下降趋势,存活组患者下降明显,但死亡组下降缓慢。IL-10水平早期处于低水平,但后期逐渐升高,存活组患者表现为轻度升高,但死亡组升高明显。结论重症肺炎存在明显的炎症失衡,早期以促炎反应为主,后期以抗炎反应为主,过度的炎症反应可导致预后不良。

Objective To investigate the dynamic changes and clinical significance of Th17 and Treg-related cytokines IL-17A and IL-10 in patients with severe community-acquired pneumonia.Methods Severe pneumonia,mild pneumonia,and healthy people who weretreated in Huizhou Central People′s Hospital from April 2020 to June 2021 during the same period were selected as the research subjects.Severe pneumonia was divided into the survival group and death group according to different outcomes.Serum IL-17A and IL-10 levels of all research subjects were detected on the day of enrollment,and on days 4-6 and 9-11 in the severe pneumonia group and were statistically analyzed.Results①The level of pro-inflammatory cytokine IL-17A in patients with severe pneumonia was significantly higher than that in mild pneumonia and healthy subjects(P<0.05),but there was no significant difference in the level of anti-inflammatory cytokine IL-10;②Dynamic monitoring showed that the level of IL-17A in patients with severe pneumonia was generally decreased.The survival group decreased significantly,but the death group decreased slowly.The level of IL-10 was low in the early stage but gradually increased in the later stage.The patients in the survival group showed a mild increase,but the increase in the death group was significant.Conclusion Severe pneumonia has an obvious inflammatory imbalance,with a pro-inflammatory response in the early stage and an anti-inflammatory response in the later stage.The excessive inflammatory response can lead to a poor prognosis.