背景:肺炎是最常见的传染病之一,主要由病毒或细菌引起。为了应对不同但部分重叠的细菌或病毒,诱导先天和适应性免疫反应,可以使用特定生物标志物的测定来定量。其中,C反应蛋白(CRP)已被确立为先天性免疫功能的标志物,而新蝶呤,它主要是在用干扰素-γ刺激时产生的,反映细胞免疫激活。
目的:我们研究了微生物学证实的病毒性或细菌性肺炎患者的炎症标志物,并研究了CRP的潜力,新蝶呤,和CRP/新蝶呤比值来区分病毒和细菌的发病机理。此外,我们检查了,患有不同类型肺炎的患者出现神经精神症状的频率。
方法:2019年诊断为冠状病毒病(COVID-19)的194例患者(n=63),细菌性肺炎(n=58),流感感染(n=10),流感和细菌重复感染(n=9),和COVID-19细菌重叠感染患者(n=54)被纳入我们的初步研究。入院后不久确定了临床和实验室参数。
结果:我们发现,细菌性肺炎患者的CRP/Neopterin比率明显较高(中位数:0.34),而COVID-19感染住院患者的CRP/Neopterin比率明显较低(中位数:0.03;p<0.001)。无论是男性还是女性,CRP/新蝶呤比值能够区分病毒和细菌病原体,而且还能够检测到初始病毒性肺炎受试者的细菌超级感染(BSI)(p<0.001)。BSI患者的CRP/新蝶呤比值(中位数0.08)明显低于仅有细菌感染的患者(中位数0.34;p<0.001)。有趣的是,与肺炎患者相比,COVID-19患者的身体功能下降(如ECOG评分所示),疲劳(84.1%)和神经系统症状(54.8%)的频率更高,由于其他潜在的病原体。在病毒性和细菌性肺炎期间报告疲劳的患者的CRP浓度低于没有它的患者。
结论:CRP/新蝶呤比值可用于区分病毒和细菌的发病机制。肺炎中神经精神症状的发生似乎取决于引起感染的病原体的种类。入院时较低的CRP浓度似乎与急性病毒和细菌感染期间的疲劳有关。
BACKGROUND: Pneumonia is one of the most common infectious diseases, mostly caused by viruses or bacteria. In response to bacteria or viruses which are different but which also are partly overlapping, innate and adaptive immune responses are induced, which can be quantified using the determination of specific biomarkers. Among these, C-reactive protein (CRP) has been established as a marker of innate immune function, whereas Neopterin, which is mainly produced upon stimulation with interferon-gamma, reflects cellular immune activation.
OBJECTIVE: We investigated inflammation markers in patients with microbiologically confirmed viral or bacterial pneumonia, and studied the potential of CRP, Neopterin, and the CRP/Neopterin ratio to distinguish between viral and bacterial pathogenesis. Furthermore, we examined, how often neuropsychiatric symptoms occur in patients suffering from different kinds of pneumonia.
METHODS: A total of 194 patients diagnosed with either coronavirus disease 2019 (COVID-19) (n = 63), bacterial pneumonia (n = 58), Influenza infection (n = 10), Influenza and a bacterial superinfection (n = 9), and COVID-19 patients with a bacterial superinfection (n = 54) were included in our pilot study. Clinical as well as laboratory parameters were determined shortly after admission.
RESULTS: We found significantly higher CRP/Neopterin ratios in patients with bacterial pneumonia (median: 0.34) and lower CRP/Neopterin ratios in patients hospitalized with COVID-19 infection (median: 0.03; p < 0.001). Both in men and in women, the CRP/Neopterin ratio was able to distinguish between viral and bacterial pathogens, but also was able to detect bacterial super-infection (BSI) in subjects with initial viral pneumonia (p < 0.001). Patients with BSI presented with significantly lower CRP/Neopterin ratios (median 0.08) than patients with bacterial infection only (median 0.34; p < 0.001). Interestingly, COVID-19 patients had a decreased physical functioning (as reflected in the ECOG score) and a higher frequency of fatigue (84.1%) and neurological symptoms (54.8%) than patients with pneumonia, due to other underlying pathogens. Patients that reported fatigue during viral and bacterial pneumonia presented with lower CRP concentrations than patients without it.
CONCLUSIONS: The CRP/Neopterin ratio is useful to differentiate between viral and bacterial pathogenesis. The occurrence of neuropsychiatric symptoms in pneumonia appears to depend on the kind of pathogen causing the infection. Lower CRP concentrations at admission appear to be related to fatigue during acute viral and bacterial infection.