Persistence of lung inflammation and lung cytokines with high-resolution CT abnormalities during recovery from SARS

Respiratory Research

Han-Pin Kuo¹  Kian Fan Chung⁴  Tzou-Yien Lin²  Shu-Min Lin¹  Horng-Chyuan Lin¹  Kuo-Hsiung Huang¹  Chun-Liang Chou¹  Yung-Liang Wan³  Chien-Ying Liu¹  Chun-Hua Wang¹ 

[1] Department of Thoracic Medicine II, Chang Gung Memorial Hospital, Taipei, Taiwan;Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Taipei, Taiwan;Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taipei, Taiwan;National Heart & Lung Institute, Imperial College & Royal Brompton Hospital, London, UK

关键词: bronchoalveolar lavage;    cytokines;    coronavirus;    T lymphocyte;    alveolar macrophages;    SARS;   

Others  :  1227305
DOI  :  10.1186/1465-9921-6-42

 received in 2005-03-09, accepted in 2005-05-11,  发布年份 2005

【 摘 要 】

Background

During the acute phase of severe acute respiratory syndrome (SARS), mononuclear cells infiltration, alveolar cell desquamation and hyaline membrane formation have been described, together with dysregulation of plasma cytokine levels. Persistent high-resolution computed tomography (HRCT) abnormalities occur in SARS patients up to 40 days after recovery.

Methods

To determine further the time course of recovery of lung inflammation, we investigated the HRCT and inflammatory profiles, and coronavirus persistence in bronchoalveolar lavage fluid (BALF) of 12 patients at recovery at 60 and 90 days.

Results

At 60 days, compared to normal controls, SARS patients had increased cellularity of BALF with increased alveolar macrophages (AM) and CD8 cells. HRCT scores were increased and correlated with T-cell numbers and their subpopulations, and inversely with CD4/CD8 ratio. TNF-α, IL-6, IL-8, RANTES and MCP-1 levels were increased. Viral particles in AM were detected by electron microscopy in 7 of 12 SARS patients with high HRCT score. On day 90, HRCT scores improved significantly in 10 of 12 patients, with normalization of BALF cell counts in 6 of 12 patients with repeat bronchoscopy. Pulse steroid therapy and prolonged fever were two independent factors associated with delayed resolution of pneumonitis, in this non-randomized, retrospective analysis.

Conclusion

Resolution of pneumonitis is delayed in some patients during SARS recovery and may be associated with delayed clearance of coronavirus, Complete resolution may occur by 90 days or later.

【 授权许可】

   
2005 Wang et al; licensee BioMed Central Ltd.

【 图 表 】

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