Comparative meta-analysis of adefovir dipivoxil monotherapy and combination therapy of adefovir dipivoxil and lamivudine for lamivudine-resistant chronic hepatitis B

Influenza is responsible for significant morbidity after transplantation. We evaluated T-helper 1/T-helper 2 (Th2) cytokines and interleukin (IL) 10 levels during influenza infection in the posttransplant setting. Serum samples from 277 transplant recipients were analyzed at influenza diagnosis and 28 days later for interferon gamma (IFN-γ), IL-4, IL-13, and IL-10. IL-13 levels were associated with protection against pneumonia and intensive care unit (ICU) admission, whereas the IFN-γ/IL-13 ratio and IL-10 levels were associated with an increased risk of pneumonia and ICU admission. This association was independent of viral load. A skewing of immune responses toward Th2 in transplant patients appears to confer protection from severe influenza infection, independent of viral load.

/pdf/cytokine-profiles-and-severity-of-influenza-infection-in-30py7fium3.pdf

Cytokine Profiles and Severity of Influenza Infection in Transplant Recipients.

Introduccion: Ademas de virulencia propia del subtipo A(H1N1)2009 del virus Influenza, hay factores del huesped no comprendidos todavia, que intervienen favoreciendo mayor morbi-mortalidad. El objetivo de este estudio fue determinar la expresion de citocinas asociada a respuesta inflamatoria aguda por virus Influenza A(H1N1)2009 y su relacion con grado de obesidad y gravedad de influenza. Material y metodos: Estudio casos-controles para el analisis clinico en Hospital General de Mexico de enero 2010 a septiembre 2011. Los casos fueron pacientes con Influenza A(H1N1) grave, los controles con influenza moderada. Para analisis de citocinas se agrego un tercer grupo sin influenza (pareados en sexo, edad e IMC). Identificacion viral por RT-PCR en exudado faringeo. Se realizo historia clinica, biometria y quimica sanguineas; por sistema Bio-plex se determino la concentracion serica de 27 citocinas. Se compararon grupos con t de Student y ANOVA, OR para riesgo de obesidad en gravedad de influenza. Analisis de factores latentes para determinar factores de citocinas. Un modelo de ANCOVA tipo I para determinar interaccion de citocinas con gravedad de influenza e IMC. Resultados: 45 pacientes con influenza: 18 moderados y 27 graves (15 criticos, 12 no criticos); 41 sujetos sin influenza. Los pacientes graves presentaron mayor IMC (26.7 ± 1.01 vs 31.4 ± 1.5, p = 0.022), mayor perimetro abdominal (92.3 ± 3.6, vs 106.8 ± 3.1 cm, p = 0.005), mayor peso, frecuencia cardiaca, respiratoria, concentra-cion serica de glucosa, TGO, DHL y CPK (p<0.05). Los obesos tuvieron mayor riesgo de ser paciente critico con influenza respecto a no obesos (OR 3.06, IC 95% 0.68, 13.78). Citocinas con diferencia significativa de acuerdo a gravedad de influenza (p < 0.05): IFNγ, TNFα, IL-2 (actividad Th1); IL-4, IL-6, IL-9, IL-13 (actividad Th2); IL-6, GM-CSF, TNFα (actividad Th17), IL-8, MCP-1, G-SCF, IL-1β (actividad de monocitos y macrofagos), IL-7, FGF-b y VEGF. Con analisis de factores latentes se determinaron 4 perfiles de citocinas en base a gravedad de influenza e IMC. El modelo de ANCOVA mostro diferencia significativa en factores 1, 2 y 4 (p < 0.05).
CONCLUSIONES. La obesidad es riesgo para mayor gravedad de influenza, con alteraciones metabolicas, hepaticas y en musculo (glucosa, TGO, CPK, DHL). La gravedad de influenza conlleva la participacion del sistema inmune innato y adquirido, con accion inflamatoria y disminucion de la anti-inflamatoria.

/pdf/efecto-de-la-obesidad-y-severidad-de-la-infeccion-por-yxxyic47e2.pdf

Efecto de la Obesidad y Severidad de la Infección por Influenza A H1N1 2009 sobre la Respuesta de Citocinas

Objective To explore the effect of cytokine in the different prognosis of patients with severe influenza A ( H1N1 ) infection. Methods 28 cases with severe influenza A ( H1 N1 ) were enrolled in the study including 16 cured cases and 12 dead cases. The cytokine level in serum was detected by Luminex technology. Results The levels of IL-2, IL-12(P70) and IFN-γ in dead group was lower than cured and normal control group and the difference were significant, P ＜ 0.05, respectively. IL-4 level in the dead group was significantly lower than cured group and normal control group, P value was 0. 0310 and 0.0012, respectively. Conclusions The Th1 cytokine level in the severe 2009 epidemic H1N1 influeaze cases shows decreased trend, and the trend is more obvious in dead cases. The decrease of Th1 cytokine may be one of reasons leading to severe clinical situation and related with the bad prognosis.

Key words: 
Influeza A virus; Cytokines

[The analysis of effect of Th1/Th2 cytokine in the different prognosis in severe influenza A (H1N1)].

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[The analysis of effect of Th1/Th2 cytokine in the different prognosis in severe influenza A (H1N1)].