ABSTRACT

Introduction

Despite adequate antibiotic coverage, community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality worldwide. It induces both a local pulmonary and a systemic inflammatory response, particularly significant in severe cases. The intensity of the dysregulated host response varies from patient to patient and has a negative impact on survival and other outcomes.

Areas covered

This comprehensive review summarizes the pathophysiological aspects of the inflammatory response in CAP, briefly discusses the usefulness of biomarkers, and assesses the clinical evidence for modulating the inflammatory pathways. We searched PubMed for the most relevant studies, reviews, and meta-analysis until August 2020.

Expert opinion

Notable efforts have been made to identify biomarkers that can accurately differentiate between viral and bacterial etiology, and indeed, to enhance risk stratification in CAP. However, none has proven ideal and no recommended biomarker-guided algorithms exist. Biomarker signatures from proteomic and metabolomic studies could be more useful for such assessments. To date, most studies have produced contradictory results concerning the role of immunomodulatory agents (e.g. corticosteroids, macrolides, and statins) in CAP. Adequately identifying the population who may benefit most from effective modulation of the inflammatory response remains a challenge.

中文翻译：

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炎症反应在社区获得性肺炎中的作用：临床意义

摘要

介绍

尽管有足够的抗生素覆盖率，但社区获得性肺炎 (CAP) 仍然是全球住院和死亡的主要原因。它诱导局部肺部和全身炎症反应，在严重的情况下尤其显着。失调的宿主反应的强度因患者而异，对生存和其他结果有负面影响。

涵盖的领域

这篇综合综述总结了 CAP 炎症反应的病理生理学方面，简要讨论了生物标志物的有用性，并评估了调节炎症通路的临床证据。我们在 PubMed 中搜索了最相关的研究、评论和荟萃分析，直到 2020 年 8 月。

专家意见

已经做出了显着的努力来识别可以准确区分病毒和细菌病因的生物标志物，实际上，以加强 CAP 的风险分层。然而，没有一个被证明是理想的，也不存在推荐的生物标志物引导算法。来自蛋白质组学和代谢组学研究的生物标志物特征可能对此类评估更有用。迄今为止，关于免疫调节剂（如皮质类固醇、大环内酯类和他汀类药物）在 CAP 中的作用，大多数研究产生了相互矛盾的结果。充分识别可能从有效调节炎症反应中获益最多的人群仍然是一个挑战。