RESUMO
Objective To study the regularity changes in serum levels of C-reactive protein(CRP)and mannose-binding lectin(MBL)in patients of community acquired pneumonia(CAP)with different syndrome patterns of traditional Chinese medicine(TCM),and to explore the new objective markers to differentiate the syndrome patterns of TCM. Methods According to The Guideline on TCM diagnosis and treatment of CAP(2011 edition),104 patients with CAP were selected and their syndromes were cassified into 3 classes and 8 patterns of syndrome:excessive class〔including following patterns:wind-heat invading lung(fengrexifei),exopathic cold and interior heat(waihanneire), accumulation of heat in lung(tanreyongfei),accumulation of phlegm-dampness in lung(tanshiyongfei)〕,deficient vital QI leading to lingering of pathogen class〔qi deficiency of lung and spleen(feipiqixu),both qi and yin deficiency (qiyinliangxu)〕,TCM critical class〔heat falling into pericardium(rexianxinbao),pathogen invasion and vital qi deterioration(xiexianzhengtuo)〕. In the same period,after physical examinations,100 healthy volunteers were chosen as healthy control group. The serum levels of CRP and MBL were detected before treatment and after treatment for 4 days and 7 days. Results Among the 104 CAP patients,the most popular class of syndrome was the excessive one(63.5%),followed by deficient vital QI leading to lingering of pathogen(19.2%)and TCM critical class(17.3%). The serum CRP level in CAP patients at each time point was higher than that in healthy control group,which had a different tendency to change over time in different syndrome patterns of TCM. With the prolongation of treatment time,the serum CRP levels in fengrexifei and waihanneire patterns returned to a normal level on the 7th day(mg/L:13.51±11.48,7.07±1.84 vs. 6.96±2.19,both P>0.05),in feipiqixu and qiyinliangxu patterns the CPR levels were higher,but its descent rate was relatively fast,and on the 7th day it was approximately normal in spite of being higher than the level in healthy control group(25.25±25.90,18.17±23.19 vs. 6.96±2.19,both P<0.05);in tanreyongfei and tanshiyongfei patterns,although the CPR levels were decreased,they still maintained at relatively high levels on the 7th day after treatment(51.70±27.33,49.28±30.57),and no downtrend of CPR was seen in rexianxinbao and xiexianzhengtuo patterns. Before treatment,the serum MBL levels in CAP patients with fengrexifei,waihanneire, tanreyongfei,tanshiyongfei,feipiqixu and qiyinliangxu patterns were higher than the level in healthy control group, and in rexianxinbao and xiexianzhengtuo patterns,the levels were lower than those in other patterns and kept being at relatively lower levels along with the prolongation of the therapy. Conclusion Serum CRP can be used as a reference marker for different syndrome patterns of TCM in patients with CAP,and low serum MBL level was a risk factor of severe syndrome patterns of TCM and a poor prognosis in CAP.
RESUMO
Objective To evaluate the significance of the mannose-binding lection (MBL) gene polymorphism at code 54 of exon 1 and MBL serum level and C-reactive protein (CRP) in the severity of community acquired pneumonia (CAP) in adults.Methods A prospective observation was conducted.104 adults Han patients with CAP hospitalized in Tianjin People's Hospital were enrolled.Frequencies of MBL54 alleles and genotypes were measured.The patients were evaluated by pneumonia severity index (PSI) score and were graded.Serum MBL was determined by enzyme linked immunosorbent assay (ELISA),and serum CRP was detected by immunoturbidimetry before and 4 days and 7 days after the treatment.100 healthy control subjects with the same region,age,gender,nationality were enrolled as control group.Serum MBL and CRP levels were compared between CAP group and the control group or among different grades of PSI,and the correlation was analyzed.Results The variation of GGC→GGC in MBL54 was found in CAP patients and controls.Similar frequencies of genotypes (x2=0.018,P=0.893) and alleles (x2=0.019,P=0.903) of MBL54 with wild type and mutant type were found between two groups.The serum MBL level (mg/L) before and 4 days and 7 days after the treatment in CAP group was increased followed by the reduction and they were 3.75 ± 1.78,4.53 ± 1.99 and 4.04 ± 1.91,respectivelv,which were significantly higher than those in control group (2.84 ± 1.41,all P＜0.01).The serum CRP levels (mg/L) in CAP group were gradually declined,and they were 66.88 ± 40.47,51.21 ± 37.54,36.91 ± 36.02,respectively,which were significantly higher than those in control group (6.96 ± 2.19,all P＜0.01).There were 12 cases with PSI grade Ⅰ,32 cases with grade Ⅱ,20 cases with grade Ⅲ,22 cases with grade Ⅳ and 18 cases with grade V in CAP patients.There was no significant difference in frequencies of MBL54 genotypes among different grades of PSI (x2=1.210,P=0.876) and between general ward and intensive care unit (x2=0.569,P=0.451).No differences in the serum MBL level before (F=1.313,P=0.279) and 4 days (F=1.705,P=0.165) and 7 days (F=1.684,P=0.170) after the treatment were found among different PSI grades.The serum MBL level 4 days after the treatment was significantly higher than that before treatment,then decreased to the level before treatment on the 7th day after treatment in CAP patients with grade Ⅱ-Ⅳ.There was significant difference in serum CRP level before (F=23.179,P=0.000) and 4 days (F=26.601,P=0.000) and 7 days (F=10.358,P=0.000) after the treatment among different PSI grades in CAP patients.The serum levels of CRP in patients with different PSI grades were gradually decreased with time prolonged,the higher the PSI grade,the more obscure the serum CRP decrease.No correlation was found between PSI grade and serum MBL before and 4 days and 7 days after the treatment (before treatment:r=-0.205,P=0.145; 4 days after treatment:r=-0.062,P=0.662; 7 days after treatment:r=-0.063,P=0.656),and positive correlation between PSI grade and serum CRP was found (before treatment:r=0.809,P=0.000; 4 days after treatment:r=0.842,P=0.000; 7 days after treatment:r=0.702,P=0.000).Conclusions The MBL54 codon genotypes had no effect on the susceptibility of CAP.The serum MBL was elevated and dynamic changes with increasing treatment time in CAP patients were shown.MBL can be used as a reaction of CAP in acute stage.But it cannot be used as an inflammatory marker for the severity of CAP.