Abstract
Purpose: In acute stroke, the oral environment influences aspiration pneumonia. We investigated salivary secretory immunoglobulin A (sIgA) which is related to oral immunity and the quantity of bacterial DNA, and examined the relationship with aspiration pneumonia.
Method (s): Thirteen patients (Median age ± quartile deviation; 81.0±7.0) who were hospitalized for the onset of stroke were enrolled in the study. Saliva samples were collected at about 10:00 a.m. on days 5, 7, 9, 11 and 13 in the hospital, and the quantity of salivary sIgA (per 1 ml) and the quantity of epidermal growth factor (EGF) which has proliferation with mucous membrane (per 1 ml) were measured by enzyme-linked immunosorbent assay (ELISA).The quantity of three bacterial DNA (Streptococcus pneumoniae: S. pneumoniae, Pseudomonas aeruginosa: P. aeruginosa, Streptococcus mitis: S. mitis) was measured by real-time polymerase chain reaction (real-time PCR). The subjects were divided into a non-pneumonia group (5 subjects) and a pneumonia group (8 subjects). The characteristics, saliva volume, the quantity of salivary sIgA and the quantity of EGF were compared in both groups and the amount of each bacterial DNA was examined by the change on each of hospital days 5, 7, 9, 11, and 13.
Result (s): In the pneumonia group, the level of consciousness on the 5th day of hospitalization was significantly lower than in the non-pneumonia group (p＜0.05), and the non-oral feeding subjects significantly outnumbered those in the non-pneumonia group. Saliva volume on day 7 and 9 of hospitalization significantly decreased in the pneumonia group (p＜0.01, p＜0.05), the quantity of sIgA on days 5, 7 and 9 of hospitalization significantly increased in the pneumonia group (p＜0.05). S. pneumoniae was detected in 3 subjects in the non-pneumonia group, and 4 subjects in the pneumonia group. An antibiotic was used for all subjects in the pneumonia group, and P. aeruginosa was detected in 4 subjects. At the same time, S. mitis and S. pneumoniae were not detected or in only a small quantity.
Conclusion: Acute stroke patients with complicated pneumonia showed decreased saliva volume, and increased sIgA. The quantity of EGF correlated with that of sIgA. S. pneumoniae was detected in the nonpneumonia subjects. In pneumonia subjects administered antibiotics, P. aeruginosa was detected instead of S. pneumoniae.
