儿童肺炎支原体肺炎免疫功能、降钙素原及C-反应蛋白变化及意义

The changes and clinic significance of immune function, serum procalcitonin and C-reactive protein in children with mycoplasma pneumoniae pneumonia

目的 检测肺炎支原体肺炎（mycoplasma pneumoniae pneumonia,MPP）患儿免疫球蛋白、CD4＋T、CD8＋T、血清降钙素原（PCT）和C-反应蛋白（CRP）的水平,探讨其改变及临床意义.方法 收集2012年11月至2013年10月诊断为MPP的患儿126例,分为大叶性肺炎组（42例）及支气管肺炎组（84例）,以同时期儿科门诊体检的健康儿童28例为正常对照组,分别测定免疫球蛋白、PCT和CRP.结果 （1）MPP患儿IgG、IgM、IgE异常率高于正常对照组（P＜0.05）,IgA异常率无明显差异（P＞0.05）;大叶性肺炎组IgG异常率高于支气管肺炎组（P＜0.05）,IgM、IgE及IgA异常率无明显差异.（2） MPP患儿CD4＋T、CD4＋ T/CD8＋T比值较正常对照组明显降低（P＜0.05）.（3）MPP患儿血清PCT及CRP水平较正常对照组明显升高（P＜0.05）.结论 MPP患儿体液免疫与细胞免疫功能紊乱在MPP发病过程中起重要作用,且病情越重,免疫功能紊乱越明显,PCT、CRP对MPP病情评估有临床指导意义.

Objective To investigate the changes of immune function,serum procalcitonin （PCT） and C-reactive protein （CRP） in children with mycoplasma pneumoniae pneumonia （MPP）,and to provide clinical evidence for immunotherapy in children with MPP.Methods A total of 126 children with MPP during their hospitalization were enrolled into lobar pneumonia group （n =42） and bronchopneumonia group （n =84）,and 28 healthy children were enrolled into normal control group.The immunoglobulin（Ig）,CD4＋T,CD8＋T,PCT and CRP of all children were determined.Results The levels of IgG,IgM and IgE of children in lobar pneumonia group and bronchopneumonia group were significantly higher than that of the normal control group （P 〈0.05）,but there were no significant differences in the level of IgA between three groups （P 〉 0.05）.The levels of IgG in lobar pneumonia group were significantly higher than that of bronchopneumonia group （P 〈 0.05）,but there were no significant differences in the levels of IgM,IgE,IgA between the two groups（P 〉0.05）.The ratios of CD4＋T and CD4＋T/CD8＋T in lobar pneumonia group and bronchopneumonia group were significantly lower than that of the normal control group（P 〈 0.05）.The levels of PCT and CRP in lobar pneumonia group and bronchopneumonia group were significantly higher than that of the normal control group （P 〈 0.05）.Conclusion Humoral immunity and cellular immune dysfunction plays an important role in pathogenesis of MPP.They are important for PCT and CRP in evaluating clinical condition and immunotherapy.