Professional Documents
Culture Documents
Original Article
3
Abstract neumonia is an infectious disease that often
Background 3QHXPRQLDLVDQLQIHFWLRXVGLVHDVHRIWHQRFFXULQJ RFFXUVLQFKLOGUHQXQGHUILYH\HDUVRIDJH,Q
LQ FKLOGUHQ XQGHU ILYH \HDUV RI DJH $W WKH WLPH RI LQIHFWLRQ GHYHORSLQJ FRXQWULHV SQHXPRQLD FDXVHV D
pro-inflammatory cytokines are released. It is thought that these high morbidity and mortality rates.1 'XULQJ
pro-inflammatory cytokines cause changes to iron homeostasis
in the body.
infection, cytokines such as pro-inflammatory
Objective 7RGHWHUPLQHDFRUUHODWLRQEHWZHHQ&53DQGVHUXP interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor
LURQOHYHOVLQFKLOGUHQZLWKSQHXPRQLD necrotizing factor-D (TNF-D) are released. It is
Methods An analytical, cross-sectional study was performed thought that these pro-inflammatory cytokines may
LQ FKLOGUHQ DJHG PRQWKV \HDUV ZLWK VHYHUH SQHXPRQLD DW lead to a change in iron homeostasis in the body.
6DQJODK +RVSLWDO 'HQSDVDU %DOL IURP $SULO1RYHPEHU
Acute phase proteins, as products of pro-inflammatory
/DERUDWRU\ H[DPLQDWLRQV LQFOXGHG &53 DQG VHUXP LURQ OHYHOV
7KHFRUUHODWLRQEHWZHHQ&53DQGVHUXPLURQOHYHOVZDVDQDO\]HG F\WRNLQHUHOHDVHDUHRIWHQHYDOXDWHGDVDQLQGLUHFW
E\3HDUVRQVFRUUHODWLRQ measure for these cytokines.
Results)URPFKLOGUHQZLWKVHYHUHSQHXPRQLDFKLOGUHQ 'XULQJ DFXWH LQIHFWLRQV &UHDFWLYH SURWHLQ
IXOILOOHGWKHLQFOXVLRQFULWHULD6XEMHFWVPHGLDQ&53OHYHOZDV &53DQDFXWHSKDVHSURWHLQLQFUHDVHVLQFRQFHQ
PJ/DQGPHGLDQ VHUXPLURQ OHYHOZDV XJG/7KH
tration in the blood as a non-specific immune
FRHIILFLHQWFRUUHODWLRQEHWZHHQ&53DQGVHUXPLURQOHYHOVZDV
3 7KH GHWHUPLQDWLRQ FRHIILFLHQW YDOXH ZDV UHVSRQVH,QGXFWLRQRI&53V\QWKHVLVLVWULJJHUHGE\
cytokines, especially IL-6, that are released in areas
Conclusion ,Q FKLOGUHQ ZLWK VHYHUH SQHXPRQLD &53 OHYHO RI LQIODPPDWLRQ /DERUDWRU\ H[DPLQDWLRQ RI &53
FRUUHODWHVQHJDWLYHO\ZLWKVHUXPLURQOHYHOV[Paediatr Indones. concentration is often performed in patients with
2012;52:38-42].
pneumonia.4
Keywords: CRP, serum iron, pneumonia
,Q 6HUELD 1DVWDVLMHYLF et al. 5 found iron DQG WKH 3XOPRQRORJ\ 'LYLVLRQ 'HSDUWPHQW RI
deficiency in adult patients suffering from community- &KLOG+HDOWK8GD\DQD8QLYHUVLW\0HGLFDO6FKRRO
DFTXLUHGSQHXPRQLD7KHLUVHUXPLURQOHYHOVVKRZHG 6DQJODK+RVSLWDO'HQSDVDU9HQRXVEORRGVSHFLPHQV
VLJQLILFDQW LPSURYHPHQW DIWHU GD\V RI WKHUDS\ IRU FRPSOHWH EORRG FRXQWV &53 DQG VHUXP LURQ
despite the absence of iron supplementation, and examinations were collected at the time patients
&53 OHYHOV FRUUHODWHG QHJDWLYHO\ ZLWK VHUXP LURQ ZHUHGLDJQRVHGZLWKVHYHUHSQHXPRQLD6HUXPLURQ
OHYHOV7KHUHKDYHEHHQIHZVLPLODUVWXGLHVSHUIRUPHG concentration was measured by Beckman Coulter
in children. The aim of our study was to determine &;XVLQJVSHFWURSKRWRPHWU\&53FRQFHQWUDWLRQ
LIWKHUHLVDFRUUHODWLRQEHWZHHQ&53DQGVHUXPLURQ ZDVPHDVXUHGE\&2%$6,17(*5$6WDWLVWLFDO
OHYHOVLQFKLOGUHQZLWKSQHXPRQLD DQDO\VHV ZHUH SHUIRUPHG XVLQJ 6336 YHUVLRQ
IRU ZLQGRZV 3HDUVRQV FRUUHODWLRQ ZDV XVHG WR
DQDO\]H WKH DVVRFLDWLRQ EHWZHHQ &53 DQG VHUXP
Methods LURQOHYHOV
Observed
80.00 Quadratic
40.00
20.00
0.00
0.00 10.00 20.00 30.00 40.00 50.00 60.00
Figure 1. Scatter plot correlation of CRP and serum iron levels in children with severe
pneumonia.
humans were injected with lipopolysaccharide, serum strength. This difference may be due to different
LURQOHYHOVJUDGXDOO\GHFUHDVHGHVSHFLDOO\LQWKHILUVW etiologies of pneumonia. In Serbia, most infections
KRXUVDQGUHDFKHGWKHORZHVWOHYHODIWHUKRXUV were bacterial, while most infections in our study
The median serum iron concentration of in our ZHUH OLNHO\ WR EH YLUDO $ OLPLWDWLRQ RI RXU VWXG\ LV
VXEMHFWVZDVJG/UDQJLQJIURP WKDWZHGLGQRWSHUIRUPYLUXVLVRODWLRQVRUSRO\PHUDVH
g/dL, lower than that of a Serbian study which FKDLQUHDFWLRQ3&5WHVWVWRGHWHUPLQHSQHXPRQLD
UHSRUWHGDPHDQVHUXPLURQOHYHOLQDGXOWSQHXPRQLD etiology. We only performed blood cultures, not lung
SDWLHQWVRIPRO/J tissue or pleural fluid. Blood cultures were sterile
dL).5 This difference may be due to subjects age for all subjects. Blood culture results do not rule
GLIIHUHQFHV7KHPHGLDQDJHRIRXUVXEMHFWVZDV out the possibility that bacteria caused our subjects
PRQWKVDQDJHYXOQHUDEOHWRLURQGHILFLHQF\14 while pneumonia, since there is generally a low incidence
the Serbian subjects were adults.5 of bacteremia during pneumonia.
A study of serum iron profiles reported mean Another limitation of our research was that
VHUXP LURQ FRQFHQWUDWLRQV LQ FKLOGUHQ ZLWK VHYHUH &53DQGVHUXPLURQOHYHOVZHUHQRWPHDVXUHGDIWHU
PDOQXWULWLRQ WR EH JG/ LQ VHYHUHO\ initiation of therapy. So we do not know if serum
malnourished children with no acute respiratory iron spontaneously increased after therapy. Since the
LQIHFWLRQWREHJG/DQGLQVHYHUHO\ WHVWLQJ WLPHV RI &53 DQG VHUXP LURQ OHYHOV YDULHG
malnourished children with acute respiratory infection the data distribution was abnormal. Also, we did
WREHJG/15 All of their results were QRWDFFRXQWIRUWKHLQIOXHQFHRIGLXUQDOYDULDWLRQRQ
higher than that in our study (25.55 g/dL). This VHUXPLURQOHYHOV)XUWKHUPRUHDOOVXEMHFWVZHUHDWULVN
GLIIHUHQFHPD\EHGXHWROHVVVHYHUHDFXWHUHVSLUDWRU\ for iron deficiency due to their dietary status. Since
infections in their study (upper acute respiratory serum ferritin was not examined in our study, we do
infections), compared to acute lower respiratory QRWNQRZLIWKHORZVHUXPLURQOHYHOVLQRXUVXEMHFWV
infections in our study.15 were caused by infection alone, or influenced by low
Iron homeostasis disruption occurs during the LURQUHVHUYHV
inflammatory process. In our study, we determined ,Q FRQFOXVLRQ &53 OHYHO ZDV QHJDWLYHO\
WKH GHJUHH RI LQIODPPDWLRQ E\ PHDVXULQJ &53 FRUUHODWHG ZLWK VHUXP LURQ OHYHO LQ FKLOGUHQ ZLWK
OHYHOVDVDQHQGUHVXOWRISURLQIODPPDWRU\F\WRNLQH VHYHUH SQHXPRQLD )XUWKHU UHVHDUFK LV QHHGHG WR
stimulation, especially IL-6. We determined iron HYDOXDWHLURQVWDWXVLQFOXGLQJIHUULWLQH[DPLQDWLRQV
KRPHRVWDVLVGLVUXSWLRQE\PHDVXULQJVHUXPLURQOHYHOV LQRUGHUWRSURYLGHPRUHVSHFLILFLQIRUPDWLRQRQWKH
:HIRXQGDQHJDWLYHFRUUHODWLRQEHWZHHQ&53DQG impact of lower respiratory tract infection on iron
VHUXPLURQOHYHOVLQFKLOGUHQZLWKVHYHUHSQHXPRQLD metabolism.
7KHFRUUHODWLRQFRHIILFLHQWZDV3
LQGLFDWLQJ WKDW LQFUHDVHG &53 OHYHOV LQ FKLOGUHQ
with pneumonia correlated to decreased serum iron Acknowledgments
OHYHOV7KHVHUHVXOWVZHUHFRQVLVWHQWZLWKD6HUELDQ
VWXG\ZKLFKVKRZHGWKDWVHUXPLURQOHYHOVQHJDWLYHO\ :H DUH GHHSO\ JUDWHIXO WR , *GH 5DND :LGLDQD 0' DQG ,%
FRUUHODWHGZLWK&53OHYHOVU 35 6XEDQDGD0'IRUWKHLUKHOSLQFRQVWUXFWLQJPHWKRGRORJ\DQG
7KHUH ZDV D SRVLWLYH UHODWLRQVKLS EHWZHHQ statistical analysis in this study.
&53DQGVHUXPLURQOHYHOVDIWHU&53FRQFHQWUDWLRQ
H[FHHGHG PJ/ DV VKRZQ E\ WKH DVFHQGLQJ
TXDGUDWLFOLQH7KLVFRQGLWLRQPD\KDYHEHHQGXHWR References
YDU\LQJWLPHVRI&53DQGVHUXPLURQWHVWLQJ7KHPRVW
rapid examination was at 2 days and the least was at %U\FH - %RVFKL3LQWR & 6KLEX\D . %ODFN 5( :+2
GD\VDIWHUSUHVHQWDWLRQRIHDUO\FOLQLFDOV\PSWRPV estimates of the causes of death in children. Lancet.
of pneumonia.
We found the correlation strength to be weaker :DOWHU72OLYDUHV03L]DUUR)0XQRV&,URQDQHPLDDQG
than that of the Serbian study, which was of medium LQIHFWLRQ1XWU5HY