Community-acquired pneumonia: evidence of functional inactivation of alpha 1 proteinase inhibitor.
Quantitative and qualitative elastase inhibitory capacity (EIC) alpha 1 proteinase inhibitor (alpha 1 PI) was measured in pulmonary arterial and systemic arterial blood of patients with community-acquired pneumonia (CAP). Eleven patients with uncomplicated CAP were compared with 16 patients with fulminating pneumonia requiring intensive care management. An appropriate increase in quantitative alpha 1 PI was demonstrated in all patients. A significant functional inactivation of alpha 1 PI was demonstrated in the ICU-treated patients that was not apparent in the uncomplicated CAP patients (p less than .01). This low EIC returned to normal 4 wk after hospital discharge in all survivors. A significant (p less than .02) difference in EIC between the pulmonary arterial and systemic arterial blood was found in the nonsurvivors on admission, which suggests that alpha 1 PI is inactivated in the lungs of patients with fulminating CAP. The present data demonstrate that alpha 1 PI is functionally inactivated in patients with fulminating CAP. This low serum functional alpha 1 PI may result in proteolytic lung damage and an unfavorable outcome.
van Eeden
S F
SF
Department of Pulmonology, South African Medical Research Council, Tygerberg Hospital.
de Beer
P
P
D000328:Adult; D001158:Arteries; D006801:Humans; D010196:Pancreatic Elastase / Q000037:antagonists & inhibitors; D011014:Pneumonia / Q000097:blood*; D011379:Prognosis; D011651:Pulmonary Artery; D012128:Respiratory Distress Syndrome / Q000097:blood; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
D000515:alpha 1-Antitrypsin; D010196:Pancreatic Elastase