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Received date: 29/12/2023 Published date: 12/01/2024 Case Report

Comparison and significance of serum 7 cytokines in children with community-acquired common pneumonia and lobar pneumonia

Dong Wei, Cao Zhenfeng, Shi Changsong*

Henan Provincial People's Hospital, Zhengzhou 450003, China.

*Corresponding author

*Shi Changsong, Dong Wei, Henan Provincial People's Hospital, Zhengzhou 450003, China.

DOI: 10.55920/JCRMHS.2024.07.001278

ABSTRACT

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.

Key words: Serum cytokines; Lobular community acquired pneumonia; Lobar pneumonia

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.

Table 1: Comparison of general data among the three groups.

Table 2: Comparison of peripheral blood serum cytokines in the 3 groups (x ̅±s)

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 long-term 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).See Table 1.

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, IL-12P70, TNF-a and IFN-γ (P > 0.05). See Table 2.

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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