单核细胞表面抗原HLA-DR及CD14＋在肺炎支原体肺炎患儿中的变化

Changes of monocyte cell surface CD_(14)^+ and HLA-DR in children with Mycoplasma pneumoniae pneumonia

目的探讨肺炎支原体肺炎(MPP)患儿外周血单核细胞表面抗原HLA-DR及CD14+表达率的变化,及其对判断病情严重程度与预后的意义。方法对2008年1月-2011年12月入住儿科的42例轻症MPP和28例重症MPP患儿的急性期、恢复期各抽取静脉血标本,采用流式细胞术检测外周血单核细胞表面抗原HLA-DR及CD14+的表达率,同时观察患儿的咳嗽缓解、发热及住院时间。结果急性期轻症组CD14+的表达率(5.39%)与对照组(5.42%)比较差异无统计学意义,而HLA-DR的表达率(66.48±10.53)%低于对照组的(75.62±11.62)%(P<0.05);重症组CD14+(1.81%)及HLA-DR的表达率(46.53±11.36)%与对照组比较明显降低(P<0.05);恢复期轻症组、重症组CD14+的表达率分别为4.82%、4.82%,HLA-DR的表达率分别为(70.26±9.73)%、(69.63±6.96)%,两组间比较差异无统计学意义,但与急性期比较差异有统计学意义(P<0.05);两组HLA-DR、CD14+表达率与咳嗽缓解、发热及住院时间的相关性分析,显示HLA-DR的表达率与发热时间存在负相关,轻症组r=-0.601,P<0.05;重症组r=-0.788,P<0.05。结论 MPP患儿外周血单核细胞表面抗原HLA-DR及CD14+与疾病严重程度有明显的相关性,病情越严重两者的表达率越低,随着疾病的恢复两者表达率升高,动态监测单核细胞表面抗原HLA-DR及CD14+有助于临床严重程度评价及预后的判断。

OBJECTIVE To explore the dynamic monitoring of peripheral mononuclear cells surface CD14＋ and HLA-DR expression rate in Mycoplasma pneumoniae pneumonia （MPP） children and its value in judging the severity and prognosis of the condition. METHODS Totally 42 children with mild MPP and 28 children with severe MPP who enrolled the pediatrics departments from Jan 2008 to Dee 2011 were selected as the study objects. The venous blood specimens were extracted respectively at the acute phase and the recovery phase, CD14 ＋ and HLA- DR expression rates were detected by flow cytometry （FCM）, while the cough relief time, fever and hospital stay were observed. RESULTS At acute phase, the expression rate of CD14 ＋ of the mild group （5.39%） and control group （5.42M） showed no significant difference, and the expression rate of HLA-DR was lower in the mild group （66.48±10.53） % than in the control group （75.62±11.62） % （P〈0.05）. The expression rates of the CD14 ＋ （ 1. 81%） and HLA-DR （46. 53±11.36）% of the severe group were significantly decreased as compared with the control group （P〈0.05）. At the recovery phase, the expression rates of CD14 ＋ were respectively 4.82% in the mild group and 4.82% in the severe group, while the expression rates of HLA-DR were respectively （70. 26%6 9.73）%in the mild group and （69. 63±6. 96%） in the severe group, as compared with the acute phase, the differences were statistically significant （P〈0.05）. The analysis of the correlation between the expression rates of CD14 ＋ and HLA-DR and cough relief time, heating time and length of stay showed that the expression rate of HLA-DR was negatively correlated with the fever （mild group r= - 0. 601, P〈0.05; severe group r= - 0. 788, P〈0. 05）. CONCLUSION There is significant correlation between the peripheral blood mononuclear cell surface antigen CD14 ＋ and HLA-DR of MPP children and the severity of disease, the more severer the disease, the lower the expression rates of the two, and the expression rates are elevated as the disease recovers. Dynamic monitoring of the CD14 ＋ and HLA-DR will help the hospital evaluate the severity and prognosis.