Vitamin D nutritional status and vitamin D regulated antimicrobial peptides in serum and pleural fluid of patients with infectious and noninfectious pleural effusions

作者：Amado Carlos A^*; Garcia Unzueta Maria T; Farinas M Carmen; Santos Francisca; Ortiz Maria; Munoz Cacho Pedro; Amado Jose A

来源：BMC Pulmonary Medicine, 2016, 16(1): 99.

DOI：10.1186/s12890-016-0259-4

• Pleural effusion
• LL-37
• Cathelicidin
• beta-defensin-2
• 25 OH vitamin D

Background: Vitamin D and vitamin D dependent antimicrobial peptides such as Cathelicidin (LL-37) and beta-defensin 2 have an important role in innate and adaptative immunity, but their role in pleural effusions has not been studied before.
Methods: Serum and pleural fluid samples from 152 patients with pleural effusion were collected, corresponding to 45 transudates and 107 exudates, 51 infectious effusions (14 complicated and 37 non-complicated), 44 congestive heart failure effusions and 38 malignant effusions. The levels of 25 OH-vitamin D, 1,25-(OH) 2-vitamin D, Vitamin D Binding Protein (VDBP), LL-37 and beta-defensin 2, both in serum and pleural fluid were evaluated in this prospective study. Differences between groups were analysed using unpaired t tests or Mann-Whitney tests. Correlations between data sets were examined using Pearson correlation coefficient or Spearman rank correlation coefficient. Diagnostic accuracy was estimated using ROC curve analysis.
Results: Low serum 25 OH vitamin D levels were found in all groups. Infectious effusions (IE) had higher serum and pleural fluid LL-37 levels compared to congestive heart failure or malignant effusions. Among IE, complicated had higher serum and pleural fluid LL-37 levels, and lower serum beta-defensin-2 levels. Positive correlations were found between serum 25 OH-vitamin D levels and serum or pleural 1,25-(OH) 2-vitamin D levels, and between 1,25-(OH) 2-vitamin D and LL-37 serum. Diagnostic accuracy of the different molecules was moderate at best.
Conclusions: Hypovitaminosis D is highly prevalent in pleural effusions. LL-37 is produced intrapleurally in IE. This production is higher in complicated IE. No evidence of pleural production of beta-defensin 2 was found in any of the groups. Diagnostic accuracy of the different molecules is at the best moderate for discriminating different types of effusions.

• 出版日期2016-7-8