儿童难治性支原体肺炎肺泡灌洗液中白三烯水平研究

Research on levels of leukotrienes in bronchoalveolar lavage fluid from children with refractory mycoplasma pneumoniae pneumonia

目的检测难治性肺炎支原体肺炎(RMPP)患儿支气管肺泡灌洗液(BALF)中LTB4及CysLTs水平,探讨RMPP患儿病变局部白三烯水平的变化及其意义。方法选择RMPP患儿(42例)为研究对象。根据是否有湿疹、过敏性鼻炎、荨麻疹及相关过敏性疾病家族史等将42例RMPP患儿分为特应性组(11例)和非特应性组(31例)。以同期因支气管异物在该院住院,异物取出4周后纤维支气管镜复查的患儿为对照(12例)。对RMPP患儿及对照患儿BALF中细胞学成分进行分析,并采用ELISA方法检测BALF中LTB4及CysLTs水平。同时测定BALF标本的蛋白含量。结果与对照组比较,RMPP组患儿BALF中细胞总数上升(P<0.05),其中以中性粒细胞上升为主(P<0.01);RMPP组患儿BALF中LTB4及CysLTs较对照组儿童均有升高,其中LTB4显著升高(P<0.05),且中性粒细胞百分比与LTB4浓度呈正相关(γ=0.742,P<0.01)。特应性组及非特应性组BALF中CysLTs较对照组差异无显著性(P>0.05)。特应性组较非特应性组BALF中CysLTs有显著升高(P<0.05)。特应性组及非特应性组BALF中LTB4较对照组均有升高,以特应性组升高为甚,各组间两两相比,差异均有显著性(P<0.05)。结论 RMPP患儿BALF细胞数显著增加,尤以中性粒细胞为甚,LTB4可能参与了RMPP患儿气道炎症的变化调节。在具有特应性体质患儿LTB4的水平高于非特应性体质者。RMPP患儿BALF中CysLTs升高不明显;但具有特应性体质患儿CysLTs含量升高明显,提示CysLTs的水平可能与机体的过敏状态相关。

[ Objective ] To detect levels of leukotrienes-B4 （LTB4） and cysteinyl leukotriene （CysLT） in bron- choalveolar lavage fluid （BALF） from children with refractory Mycoplasma pneumoniae pneumonia （RMPP） and ex- plore the relationship between children RMPP and atopic status. [Methods ] Patients with RMPP （11=42） were retro- spectively enrolled. The specific antibody of MP which was detected by partial agglutinate method. All the patients were given flexible fiberoptie bronchoscopy and their BALF were collected. All the patients were divided into two group according to whether they have eczema, allergic rhinitis, urticaria and family history of anaphylactic disease or not, atopie group （n= 11） and non-atopic group （n=31）. Meanwhile, re-examined cases （n=12） who were given the operation of removing airway foreign bodies 4 weeks before were taken as control group. The differential cell count in BALF was analyzed. The levels of LTB4 and cysteinyl CysLT in BALF were measured by enzyme linked im- munosorbent assay （ELISA）.At the same time, the levels of protein in BALF were detected. [ Results ] Compared with the control group, the total cells in BALF from children with RMPP increased significantly （P 〈0.05）, and the per- centage of neutrophil increased higher significantly （P 〈0.05） compared with the control group, the LTB4 in BALF from children with RMPP increased significantly （P 〈0.05）, the CysLTs increased not significantly（P 〉0.05）, and the percentage of neutrophil in BALF were positively correlated with the level of LTB4 （7=0.742, P 〈0.01）. The LTB4 in BALF of atopic group increased significantly （P 〈0.05）, the CysLTs increased not significantly （P 〉0.05）, and the LTB4 in BALF of non-atopic group increased significantly （P 〈0.05）, the CysLTs was not significantly changed （P 〉 0.05）. Compared with the non-atopic group, the LTB4 and CysLTs in BALF of atopic group increased significantly （P 〈0.05）. [ Conclusion ] The total cells, especially the percentage of neutrophil in BALF from children with RMPP in- creased significantly, maybe it is caused by the increasing of LTB4. And in atopic children the level of LTB4 are higher than non-atopic children. The CysLTs in BALF from children with RMPP have no difference, but in atopic children CysLTs have increased significantly, it suggest CysLTs may play a significant role in hypersensitiveness sta- tus, but whether CysLTs will increasing in RMPP or not is still uncertain.