NEW ASPECTS OF THE USE OF PROTEIN TISSUE-SPECIFIC MARKERS IN THE ESTIMATION OF SEVERITY OF COMMUNITY-ACQUIRED PNEUMONIA

The purpose of the study was to assess the associations of proteins of pulmonary surfactants A (SP-A) and D (SP-D) with the severity of community-acquired pneumonia. Material and methods. A survey of 188 patients diagnosed with community-acquired pneumonia (CAP). The average age of the examined patients was 54.3 ± 16.5 years (M ± SD). In 102 patients (54.3 %) severe CAP was verified. All patients underwent clinical, functional, diagnostic and laboratory studies. Results and discussion. It was determined that SP-A and SP-D content was significantly higher in patients with severe CAP compared to patients with a mild course of this disease. The direct association of severe CAP with an elevated SP-AP level, directly associated with an increase in the concentration of C-reactive protein in the blood and erythrocyte sedimentation rate, have been confirmed in early studies. Using partial correlation analysis, it was established that the severe course of CAP is directly related to SP-A (r = 0.221; p = 0.003) and SP-D content (r = 0.262; p < 0.001) regardless of age, smoking, and body weight. Thus, direct associations of SP-A and SP-D with a severe course of CAP reflect the high pathogenetic significance of these protective factors in infectious lung damage.

1. Kovalkova N.A., Ragino Yu.I., Logvinenko N.I., Merekina E.V., Voevoda M.I. The value of surfactant proteins in the diagnosis of therapeutic diseases. Terapevticheskiy arkhiv = Therapeutic Archive. 2015; (1): 115–119. [In Russian].

2. Kruglyakova L.V., Naryshkina S.V. Severe community-acquired pneumonia: diagnostics and treatment (review). Byulleten’ fiziologii i patologii dykhaniya = Bulletin of Physiology and Pathology of Respiration. 2016; (59): 98–108 [In Russian].

3. Ragino Yu.I., Nikolaev K.Yu., Kharlamova O.S., Stakhneva E.M., Voevoda M.I. Associations of blood level of surfactant protein A with the clinical characteristics of pneumonia. Sibirskiy nauchnyy meditsinskiy zhurnal = Siberian Scientific Medical Journal. 2017; 37 (5): 16–20. [In Russian].

4. Chuchalin A.G., Sinopalnikov A.I., Kozlov R.S., Avdeev S.N., Tyurin I.E., Rudnov V.A., Rachina S.A., Fesenko O.V. Russian Respiratory Society (RRO), Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC). Clinical recommendations for the diagnosis, treatment and prevention of severe community-acquired pneumonia in adults. Pulmonologiya = Pulmonology. 2014; (4): 13–48. [In Russian].

5. Chuchalin A.G., Sinopalnikov A.I., Kozlov R.S., Tyurin I.E., Rachina S.A. Practical guidelines for the prevention, diagnosis, and treatment of community acquired pneumonia in adults (physician’s manual). Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya = Clinical Microbiology and Antimicrobial Chemotherapy. 2010; 12 (3): 186–225. [In Russian].

6. Brown J. Community-acquired pneumonia. Clin. Med. 2012; 12 (6): 538–543. doi: 10.7861/clinmedicine. 12-6-538.

7. Du J., Abdel-Razek O., Shi Q., Hu F., Ding G., Cooney R.N., Wang G. Surfactant protein D attenuates acute lung and kidney injuries in pneumonia-induced sepsis through modulating apoptosis, inflammation and NF-κB signaling. Sci. Rep. 2018; 8 (1): 15393.

8. Eisner M.D., Parsons P., Matthay M.A., Ware L., Greene K. Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury. Thorax. 2003; 58 (11): 983–988.

9. Garcia-Laorden M.I., Rodriguez de Castro F., Sole-Violan J., Rajas O., Blanquer J., Borderias L., Aspa J., Briones M.L., Saavedra P., Marcos-Ramos J.A., Gonzalez-Quevedo N., Sologuren I., Herrera-Ramos E., Ferrer J.M., Rello J., Rodriguez-Gallego C. Influence of genetic variability at the surfactant proteins A and D in community-acquired pneumonia: a prospective, observational, genetic study. Crit. Care. 2011; 15: ID R57. doi: 10.1186/cc10030.

10. Leth-Larsen R., Nordenbaek C., Tornoe I., Moeller V., Schlosser A., Koch C., Teisner B., Junker P., Holmskov U. Surfactant protein D (SP-D) serum levels in patients with community-acquired pneumonia. Clin. Immunol. 2003; 108 (1): 29–37. doi: 10.1016/s1521-6616(03)00042-1.

11. Spoorenberg S., Vestjens S., Rijkers G.T., Meek B., van Moorsel C.H., Grutters J.C., Bos W.J. YKL-40, CCL18 and SP-D predict mortality in patients hospitalized with community-acquired pneumonia. Respirology. 2016; 22 (3): 542–550. doi: 10.1111/resp.12924.

12. Wang L.L., Zheng S.Y., Ren L., Xiao Q.Y., Long X.R., Luo J., Li Q.B., Deng Y., Xie X.H., Liu E.M. Levels of surfactant proteins A and D in bronchoalveolar lavage fluid of children with pneumonia and their relationships with clinical characteristics. Zhongguo Dang Dai Er Ke Za Zhi. 2016; 18 (5). 386–390. [In Chinese].