Differences of TNF- α,IL-6 and Gal-3 in lobar pneumonia and bronchial pneumonia caused by mycoplasma pneumoniae

Abstract

OBJECTIVE:

To investigate the differences of tumor necrosis factor- $\alpha$ (TNF- $\alpha$ ), interleukin-6 (IL-6) and galectin-3 concentrations in lobar pneumonia and bronchopneumonia induced by mycoplasma pneumoniae (MP) in children and to explore these related factors predicting the severity of MP.

METHODS:

A total of 148 children with mycoplasma pneumoniae pneumonia (MPP) and 32 healthy controls were analyzed from March 2017 to August 2018 in our province. Clinical information was collected from the hospitalized MP patients. The 148 patients with MPP were divided into two groups: lobar pneumonia group and bronchial pneumonia group. The 32 healthy children were considered the control group. The concentrations of TNF- $\alpha$ , IL-6 and Gal-3 were examined in the serum of 148 children patients with MPP and 32 healthy children by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA).

RESULTS:

The TNF- $\alpha$ , IL-6 and Gal-3 levels were obviously higher in both the lobar pneumonia and bronchial pneumonia groups, compared to those in the control group. Furthermore, these levels were significantly higher in the lobar pneumonia group, compared to the bronchial pneumonia group. After treatment, the levels of TNF- $\alpha$ , IL-6 and Gal-3 totally descended during the recovery period.

CONCLUSION:

There are differences in serum TNF- $\alpha$ , IL-6 and Gal-3 concentrations in lobar pneumonia and bronchial pneumonia caused by MP in children. In general, the TNF- $\alpha$ , IL-6 and Gal-3 levels were significantly higher in the lobar pneumonia group, when compared to the bronchial pneumonia group. This was because most lobar pneumonia cases are much more serious than bronchial pneumonia. Moreover, it has been proven that TNF- $\alpha$ , IL-6 and Gal-3 may play an important role in the pathogenesis development of MPP. At the same time, these are important issues in diagnosing MPP.

Keywords

Mycoplasma pneumonia lobar pneumonia bronchial pneumonia tumor necrosis facto-alpha TNF-α interleukin-6 IL-6 galctin-3 Gal-3

1. Introduction

Mycoplasma pneumoniae (MP) is one of the most common pathogens of community acquired pneumonia (CAP) [1, 2]. Lobar pneumonia is an acute inflammation that involves the alveoli, and this rapidly spreads to a pulmonary segment or the entire lobule. This is mainly caused by bacteria, such as pneumococcus or mycoplasma infection [3, 4]. The incidence of lobar pneumonia in children is gradually increasing [5]. Streptococcus pneumoniae has been the most common pathogen of lobar pneumonia in the past. In the past few years, the pathogen of childhood lobar pneumonia has dramatically changed, and was replaced by MP [6]. In addition, the incidence of lobar pneumonia in children has exhibited a gradual rising trend, and the main clinical symptoms of the disease are high fever, cough, expectoration, chills and so on [5]. The incidence of mycoplasma pneumoniae pneumonia (MPP) in our city is about 35%. The disease occurs every season, but the MPP incidence in the first and second quarter was much higher than in the third and fourth quarter. The highest incidence occurs in the second quarter. The ages with highest incidence rates are 4 $\sim$ 6 and 7 $\sim$ 9 years. Urban children have higher MPP incidence than rural children [7, 8]. The mortality for lobar pneumonia accounts for 15% of the mortality in children worldwide. Thus, it is of paramount importance to explore reasonable and effective treatment methods [9, 10].

When mycoplasma or other pathogens infect an organism, the continuous stimulation of inflammatory factors could damage vascular endothelial cells [11]. Inflammatory cells would release a variety of inflammatory cytokines when children with lobar pneumonia are exposed to both hypoxia and endotoxin, during which tumor necrosis factor- $\alpha$ (TNF- $\alpha$ ), interleukin-6 (IL-6) and galectin-3 (Gal-3) play important roles in the pathogenesis of mycoplasma pneumoniae pneumonia. In the present study, the clinical data of 148 hospitalized children with MPP and 32 healthy controls were summarized and reported.

2. Data and methods

2.1 Research object and groups

A total of 148 children with no history of receiving pneumococcal vaccine (PVC) 7, 10, or 13, who were hospitalized from March 2017 to August 2018, were included in the present study. Among these children, 87 children were male and 61 were female, and their age ranged from 2–11 years. All cases met the diagnostic criteria of the Chu Fu T’ang Practical Paidonosology (Version 8) lobar pneumonia [12]: The clinical manifestations were fever, cough and shortness of breath; Physical examination: Breathing sounds in the lungs were thick, rales were audible, local breathing sounds were reduced, and the percussion sounds were voiced or flat; The chest X-ray revealed uniform consolidation shadows in the lobes. At the same time, chest X-ray, chest computed tomography (CT), electrocardiogram (ECG), and tests on myocardial enzyme, erythrocyte sedimentation rate (ESR), bacterial culture, Epstein-Barr virus (EBV) antibody, cytomegalovirus antibody, tuberculosis antibody, coagulation test and liver function test were performed. Tuberculosis, EBV and cytomegalovirus infection, congenital heart disease, and other basic diseases were excluded. Prior to admission, no azithromycin, hormone, or immunomodifier was used. Among these patients, 78 had lobar pneumonia (lobar pneumonia group), while 70 had bronchial pneumonia (bronchial pneumonia group). In the lobar pneumonia group, 42 patients were male and 36 patients were female, and their age ranged from 2–11 years, with an average age of 5.2 years. In the bronchial pneumonia group, 45 patients were male and 35 patients were female, and their age ranged from 2–10 years, with an average age of 4.1 years old. All the patients received azithromycin combined with ceftriaxone sodium for lobar pneumonia, human intravenous gamma globulin for pleural effusion patients, and fiber bronchoscope alveolar lavage and hormone for more than half of lobar pneumonia patients. Discharge was standard for each group: The body temperature was normal for more than three days, the symptoms and signs basically disappear, and the shadow part in the lungs completely disappears.

There were 32 subjects in the normal control group, which comprised of normal children upon physical examination during the same period of hospital outpatient. The age of the subjects ranged from 3–8 years. Among these subjects, 17 subjects were male and 15 subjects were female, and their average age was 4.7 years. These subjects had no recent history (i.e. within last two months) of acute infectious diseases and never received PCV7, 10, or 13. The age or gender comparative difference of each group were not statistically significant ( $P>$ 0.05) and were comparable.

2.2 Specimen acquisition

For the 148 patients with MPP for two days and 10 days after admission, peripheral venous blood was aseptically drawn on an empty stomach, and placed at room temperature for two hours. Then, the collected blood was centrifuged at 1,000 RPM for 20 minutes, and the liquid supernatant obtained for cryopreservation at $-$ 20 ${}^{\circ}$ C. Next, blood drawing, centrifugation and cryopreservation were performed for the 32 healthy subjects in the normal control group through the same method. Positive serum MP-IgM was determined by microparticle agglutination, with an acute phase titer of $\geqslant$ 1:160. All the specimens were examined in the same lab. Meanwhile, special personnel were responsible for the operation, and strictly followed the instructions.

2.3 Statistical analysis

Statistical analysis was conducted through the SPSS 16.0 statistical software. The measurement data was presented as mean $\pm$ standard deviation. Variance analysis was performed for comparisons between multiple groups, while paired $t$ -test was used for comparisons before and after the grouping. $P<$ 0.05 was considered statistically significant.

3. Results

3.1 Detection results for serum TNF- $\alpha$ concentrations in each group

The serum TNF- $\alpha$ concentration before and after treatment was both significantly higher in the lobar pneumonia group, when compared to the normal control group. Similarly, the serum TNF- $\alpha$ concentration before and after treatment was both significantly higher in the bronchial pneumonia group, when compared to the normal control group. However, the serum TNF- $\alpha$ concentration in both groups significantly decreased after treatment. There was no significant difference between the bronchial pneumonia group and normal control group after treatment, while the serum TNF- $\alpha$ concentration was significantly higher in the lobar pneumonia group, when compared to the control group (Table 1).

Table 1
The serum TNF- $\alpha$ concentration before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Group	N	TNF- $\alpha$	$P$
Control group	32	42.00 $\pm$ 18.56
Bronchial pneumonia group
Before treatment	70	65.84 $\pm$ 21.30 ${}^{\blacktriangle}$	0.000 ${}^{\blacktriangle}$
After treatment	70	45.78 $\pm$ 15.59 ${}^{\vartriangle}$	0.359 ${}^{\vartriangle}$
Lobar pneumonia group
Before treatment	78	75.92 $\pm$ 28.08 ${}^{\blacksquare}$	0.000 ${}^{\blacksquare}$
After treatment	78	55.54 $\pm$ 22.51 ${}^{\bigstar}$	0.010 ${}^{\bigstar}$

${}^{\blacktriangle}P$ , ${}^{\blacksquare}P$ and ${}^{\bigstar}P$ were all lower than 0.05, which indicate that there was a significant difference between the bronchial pneumonia group and normal control group before treatment, and the difference was statistically significant. There was a significant difference between the normal control group and lobar pneumonia group before and after treatment, and the difference was statistically significant. ${}^{\vartriangle}P>$ 0.05 means that there was no obvious difference between the bronchial pneumonia group after treatment and the normal control group.

3.2 Detection results of serum IL-6 concentrations in each group

The serum IL-6 concentration before and after treatment was both significantly higher in the lobar pneumonia group, when compared to the normal control group. Similarly, the serum IL-6 concentration before and after treatment was both significantly higher in the bronchial pneumonia group, when compared to the normal control group. The serum IL-6 concentrations in both groups significantly decreased after treatment. There was no significant difference between the bronchial pneumonia group and normal control group after treatment. However, there were differences between the normal control group and lobar pneumonia group after treatment (Table 2).

Table 2
The serum IL-6 concentrations before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Group	N	IL-6	$P$
Control group	32	37.21 $\pm$ 13.73
Bronchial pneumonia group
Before treatment	70	51.18 $\pm$ 23.40 ${}^{\blacktriangle}$	0.002 ${}^{\blacktriangle}$
After treatment	70	37.79 $\pm$ 18.12 ${}^{\vartriangle}$	0.517 ${}^{\vartriangle}$
Lobar pneumonia group
Before treatment	78	72.83 $\pm$ 31.70 ${}^{\blacksquare}$	0.000 ${}^{\blacksquare}$
After treatment	78	52.01 $\pm$ 24.06 ${}^{\bigstar}$	0.002 ${}^{\bigstar}$

${}^{\blacktriangle}P$ , ${}^{\blacksquare}P$ and ${}^{\bigstar}P$ ware all lower than 0.05, which indicate that there was a significant difference between the bronchial pneumonia group before treatment, lobar pneumonia group before and after treatment, and the normal control group, and the differences were statistically significant. ${}^{\vartriangle}P>$ 0.05 means that there was no obvious difference between the bronchial pneumonia group after treatment and the normal control group.

3.3 Detection results of serum Gal-3 concentrations in each group

The serum Gal-3 concentration before and after treatment was both significantly higher in the lobar pneumonia group, when compared to the normal control group. Similarly, the serum Gal-3 concentration before and after treatment was both significantly higher in the bronchial pneumonia group, when compared to the control group. The serum IL-6 concentration in both groups significantly decreased after treatment. However, there was no significant difference between the bronchial pneumonia group and normal control group after treatment. Furthermore, there were significant differences between the normal control group and lobar pneumonia group after treatment (Table 3).

Table 3
The serum Gal-3 concentrations before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Group	N	Gal-3		$P$
Control group	32	48.40	$\pm$ 25.10
Bronchial pneumonia group
Before treatment	70	67.41	$\pm$ 27.76 ${}^{\blacktriangle}$	0.004 ${}^{\blacktriangle}$
After treatment	70	47.24	$\pm$ 18.17 ${}^{\vartriangle}$	0.823 ${}^{\vartriangle}$
Lobar pneumonia group
Before treatment	78	108.89	$\pm$ 34.22 ${}^{\blacksquare}$	0.000 ${}^{\blacksquare}$
After treatment	78	68.94	$\pm$ 24.15 ${}^{\bigstar}$	0.004 ${}^{\bigstar}$

${}^{\blacktriangle}P$ , ${}^{\blacksquare}P$ and ${}^{\bigstar}P$ ware all lower than 0.05, which indicate that there was a significant difference between the bronchial pneumonia group before treatment, lobar pneumonia group before and after treatment, and the normal control group, and the difference was statistically significant. ${}^{\vartriangle}P>$ 0.05 means that there was no obvious difference between the bronchial pneumonia group after treatment and the normal control group.

3.4 Concentration comparison of TNF-

\alpha

, IL-6 and Gal-3 before and after treatment

The TNF- $\alpha$ , IL-6 and Gal-3 levels in the bronchial pneumonia group were significantly higher before treatment, when compared to those after treatment. Furthermore, TNF- $\alpha$ , IL-6 and Gal-3 levels in the lobar pneumonia group were significantly higher before treatment, when compared to those after treatment (Table 4).

Table 4
Comparison of the bronchial pneumonia group before and after treatment, and comparison of the lobar pneumonia group before and after treatment

Group	N	TNF- $\alpha$	IL-6	Gal-3
Before treatment of bronchial pneumonia group	70	65.84 $\pm$ 21.30 ${}^{\blacktriangle}$	51.18 $\pm$ 23.40 ${}^{\blacksquare}$	67.41 $\pm$ 27.76 ${}^{\vartriangle}$
After treatment of bronchial pneumonia group	70	45.78 $\pm$ 15.59 ${}^{\blacktriangle}$	37.79 $\pm$ 18.12 ${}^{\blacksquare}$	47.24 $\pm$ 18.17 ${}^{\vartriangle}$
$P$		0.030 ${}^{\blacktriangle}$	0.013 ${}^{\blacksquare}$	0.018 ${}^{\vartriangle}$
Before treatment of lobar pneumonia group	78	75.92 $\pm$ 28.08 ${}^{\square}$	72.83 $\pm$ 31.70 ${}^{\bigstar}$	108.89 $\pm$ 34.22 ${}^{\blacklozenge}$
After treatment of lobar pneumonia group	78	55.54 $\pm$ 22.51 ${}^{\square}$	52.01 $\pm$ 24.06 ${}^{\bigstar}$	68.94 $\pm$ 24.15 ${}^{\blacklozenge}$
$P$		0.001 ${}^{\square}$	0.002 ${}^{\bigstar}$	0.000 ${}^{\blacklozenge}$

${}^{\blacktriangle}P$ , ${}^{\blacksquare}P$ , ${}^{\vartriangle}P$ , ${}^{\square}P$ , ${}^{\bigstar}P$ and ${}^{\blacklozenge}P$ were all lower than 0.05, indicating that there was a significant difference in TNF- $\alpha$ , IL-6 and Gal-3 between the bronchial pneumonia group and lobar pneumonia group before and after treatment, and the difference was statistically significant.

3.5 Group comparison over the concentrations of TNF-

\alpha

and IL-6 before and after treatment

The TNF- $\alpha$ , IL-6 and Gal-3 levels before treatment were significantly higher in the lobar pneumonia group, when compared to those in the bronchial pneumonia group. In addition, the TNF- $\alpha$ , IL-6 and Gal-3 levels after treatment were significantly higher in the lobar pneumonia group, when compared to those in the bronchial pneumonia group (Table 5).

Table 5
Comparisons between the bronchial pneumonia group and lobar pneumonia group before and after treatment

Group	N	TNF- $\alpha$	IL-6	Gal-3
Before treatment of bronchial pneumonia group	70	65.84 $\pm$ 21.30 ${}^{\blacktriangle}$	51.18 $\pm$ 23.40 ${}^{\blacksquare}$	67.41 $\pm$ 27.76 ${}^{\vartriangle}$
Before treatment of lobar pneumonia group	78	75.92 $\pm$ 28.08 ${}^{\blacktriangle}$	72.83 $\pm$ 31.70 ${}^{\blacksquare}$	108.89 $\pm$ 34.22 ${}^{\vartriangle}$
$P$		0.038 ${}^{\blacktriangle}$	0.028 ${}^{\blacksquare}$	0.000 ${}^{\vartriangle}$
After treatment of bronchial pneumonia group	70	45.78 $\pm$ 15.59 ${}^{\square}$	37.79 $\pm$ 18.12 ${}^{\bigstar}$	47.24 $\pm$ 18.17 ${}^{\blacklozenge}$
After treatment of lobar pneumonia group	78	55.54 $\pm$ 22.51 ${}^{\square}$	52.01 $\pm$ 24.06 ${}^{\bigstar}$	68.94 $\pm$ 24.15 ${}^{\blacklozenge}$
$P$		0.031 ${}^{\square}$	0.013 ${}^{\bigstar}$	0.018 ${}^{\blacklozenge}$

4. Discussion

Mycoplasma pneumoniae (MP) is a kind of microbe somewhere between a bacterium and a virus. It is the smallest known viable pathogen able to present in spherical, rod-shaped, filiform and other forms through the bacterial filter [13]. MP is the pathogen of MPP, and is mainly transmitted by airborne droplets from the oral and nasal secretions of patients in the acute phase, which could cause infection on each area of the respiratory tract [14]. MPP is a lower respiratory tract infection caused by MP, and its lesions are mainly interstitial pneumonia and bronchial pneumonia [15]. In recent years, a number of studies have reported that there is a significant increase in MPP with lobar pneumonia. In China, MPP imaging has revealed a gradual increase in the proportion of lobar pneumonia change [5]. This disease is relatively serious, and there are many complications. The pathogenesis of mycoplasma pneumoniae pneumonia (MPP) with lobar pneumonia involvement remains unclear and indefinite. This might be correlated to the immunological mechanism. Children are in a stage where various systems have not been completely developed, and their immune function is not sound, making it vulnerable to a variety of bacterial pathogens [16]. According to research findings, the onset acute phase of children patients with lobar pneumonia is cellular immunity and humoral immunity dysfunction or depression. Serum TNF- $\alpha$ and IL-6 have been both used as mediators of inflammation, and are important participants in the body’s stress response, which are capable of effectively reflecting the stress state and infection state of the human body [17].

As confirmed in the clinic, TNF- $\alpha$ remains at a high level. Upon analysis, the children could suffer from cardiopulmonary injury, which could cause tissues and organs to be in a low blood oxygen condition, and subsequently lead to a body immunity chain reaction. According to relevant research [18], the TNF- $\alpha$ index can accurately evaluate and determine the development status of children with severe pneumonia.

There are significant differences between lobar pneumonia and bronchial pneumonia in frequent onset ages, clinical manifestations and chest radiography. Serum TNF- $\alpha$ concentration is proportional to the severity of systemic inflammatory response.

IL-6 is a cytokine produced by a variety of inflammatory cells, including T-cells, monocytes, astrocytes and microglia, which is closely correlated to immune inflammatory response. It is also an important factor in inflammatory response. Besides, it can stimulate liver cells to synthesize acute phase protein, participate in inflammatory reactions, and act on the process of pneumonia. Additionally, it has the function of regulating immune response and immune period reaction and can even participate in the body inflammatory reaction and anti-infective effect. At present, it has been considered that the disequilibrium of pro-inflammatory mediators (IL-6) and anti-inflammatory mediators is of much concern in lung infection [19, 20, 21]. It also has been reported that IL-6 is an indicator closely associated with lung disease, which provides an important reference for the diagnosis and evaluation of elderly patients with pulmonary infection, and has important clinical significance for improving prognosis and reducing mortality [22].

By measurement, IL-6 concentration was significantly higher in children with lobar pneumonia than in children with bronchial pneumonia. The excessive secretion of IL-6 further aggravates the condition of IL-6 lobular pneumonia. During pneumonia infection, although IL-6 activates both pro-inflammatory and anti-inflammatory processes, it is primarily pro-inflammatory [23]. A higher IL-6/solubility IL-6 receptor (sIL-6R) means a greater the risk of death. When MPP occurs, the damage to the alveolar epithelium would cause inflammation in the lungs, causing the levels of TNF- $\alpha$ and IL-6 in bronchial alveolar lavage fluid and serum to increase [24].

Some scholars have reported that the levels of TNF- $\alpha$ and IL-6 in alveolar lavage fluid in MPP patients were positively correlated to the degree of pulmonary infection in patients with severe MPP. There have also been overseas reports [24] showing that IL-6 level could reflect the severity of pneumonia. Furthermore, some studies have suggested that serum TNF- $\alpha$ and IL-6 levels can be used as an important index to diagnose the severity of lobar pneumonia in children.

Gal-3 (galectin) is a member of $\beta$ -galactoside animal lectin family, which is often involved in cell proliferation, migration, adhesion, differentiation, apoptosis and inflammatory response in epithelial cells, macrophages and immune cells [25].

Gal-3 is one of the most widely studied members of the Galectins family. Gal-3 participates in the formation of central immune tolerance, enhances natural immune function, and initiates the adaptive immune response. As a powerful pro-inflammatory agent, it has been attached with great importance in recent years. Gal-3 is not only engaged in mediating immune response in many inflammatory diseases, but may serve as a new target to control inflammation.

In the present study, it was found that the TNF- $\alpha$ , IL-6 and Gal-3 concentrations of children patients were higher in the lobar pneumonia group and bronchial pneumonia group, when compared to those in the normal control group. In addition, TNF- $\alpha$ , IL-6 and Gal-3 levels were significantly higher in lobar pneumonia group before pneumonia treatment, when compared to those in the bronchial pneumonia group before pneumonia treatment. At the same time, the above indicators in both groups significantly decreased after treatment. These results suggest that the TNF- $\alpha$ , IL-6 and Gal-3 levels of children with MPP increased in the acute phase. However, after treatment, their conditions improved, and the serum levels of TNF- $\alpha$ , IL-6 and Gal-3 of children patients gradually decreased. After the pneumonia treatment, the serum TNF- $\alpha$ and IL-6 levels remained slightly higher in the bronchial pneumonia group compared to those in the normal control group. While the Gal-3 level was slightly lower compared to the normal control group. However, the differences were not statistically significant, indicating that the serum concentrations of TNF- $\alpha$ , IL-6 and Gal-3 gradually decreased after the treatment of bronchial pneumonia, and that the serum Gal-3 concentration was close to the normal level when the disease was cured.

Nevertheless, after treatment, the TNF- $\alpha$ , IL-6 and Gal-3 levels remained significantly higher in the lobar pneumonia group, when compared to those in the normal control group, suggesting that the above indicators decreased more slowly in children with MPP, when compared to children with bronchial pneumonia. This reason might be because lobar pneumonia is more severe than bronchial pneumonia in most cases.

Thus, it can be considered that TNF- $\alpha$ , IL-6 and Gal-3 concentrations was higher in children patients with lobar pneumonia, when compared to children patients with bronchial pneumonia. In addition, the concentration scale of TNF- $\alpha$ , IL-6 and Gal-3 is closely correlated to the severity of MPP. This suggests that TNF- $\alpha$ , IL-6 and Gal-3 participates in the inflammatory pathological process of MPP.

From what has been discussed above, as a major nonspecific inflammatory factor in MP infection, TNF- $\alpha$ , IL-6 and Gal-3 are involved in the pathological process of pulmonary inflammation, and the content is closely correlated to the severity of MPP. In general, the serum concentration of TNF- $\alpha$ , IL-6 and Gal-3 is higher for lobar pneumonia than for bronchial pneumonia. Therefore, the serum levels of TNF- $\alpha$ , IL-6 and Gal-3 can be used as a reference indicator for the assessment of disease severity, and as an important reference basis for the clinical treatment of lobar pneumonia and bronchial pneumonia caused by MP.

Finally, this research comprised a sample of patients associated with our city that reported experiencing MPP symptoms and therefore may not be representative of all patients induced by MP.

Footnotes

Acknowledgments

The authors are grateful to everyone who helped with the article. The study was funded by the Zibo Science and Technology Development Plan Project (2017kj010099).

Conflict of interest

The authors declare that they have no competing interests.

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Differences of TNF- α,IL-6 and Gal-3 in lobar pneumonia and bronchial pneumonia caused by mycoplasma pneumoniae

Abstract

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1. Introduction

2. Data and methods

2.1 Research object and groups

2.2 Specimen acquisition

2.3 Statistical analysis

3. Results

3.1 Detection results for serum TNF- α concentrations in each group

Table 1 The serum TNF- α concentration before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Table 2 The serum IL-6 concentrations before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Table 3 The serum Gal-3 concentrations before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Table 4 Comparison of the bronchial pneumonia group before and after treatment, and comparison of the lobar pneumonia group before and after treatment

Table 5 Comparisons between the bronchial pneumonia group and lobar pneumonia group before and after treatment

Footnotes

Acknowledgments

Conflict of interest

References

3.1 Detection results for serum TNF- $\alpha$ concentrations in each group

Table 1
The serum TNF- $\alpha$ concentration before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Table 2
The serum IL-6 concentrations before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Table 3
The serum Gal-3 concentrations before and after treatment in the bronchial pneumonia group and lobar pneumonia group were compared with the normal control group

Table 4
Comparison of the bronchial pneumonia group before and after treatment, and comparison of the lobar pneumonia group before and after treatment

Table 5
Comparisons between the bronchial pneumonia group and lobar pneumonia group before and after treatment