重症肺炎支原体肺炎患儿血清Toll样受体4／髓样分化因子88及D-二聚体水平检测的意义

Clinical significance of serum Toll - like receptor 4/Myeloid differentiation factor 88 and D - dimer level detec-tion in children with serious Mycoplasma pneumoniae pneumonia

目的探讨重症肺炎支原体肺炎（MPP）患儿血清Toll样受体4（TLR4）／髓样分化因子88（MyD88）及D-二聚体水平的变化及其临床意义。方法选取徐州医科大学附属医院2015年6月至2016年12月收治的确诊为MPP住院患儿90例，其中重症MPP组42例、轻症MPP组48例，采用免疫比浊法检测患儿血清D-二聚体水平，Westernblot法检测血清TLR4、MyD88和核因子（NF）．KB的表达。结果1．重症MPP组D-二聚体[（1850．12±153．50）μg／L比（297．36±27．42）μg／L]、白细胞计数（WBC）[（11．52±0．38）×10^9／L比（7．98±0．62）×10^9／L]、中性粒细胞比例（N）（0．87±0．01比0．55±0．01）、C反应蛋白（CRP）[（64．59±7．93）mg／L比（19．79±6．38）mg／L]、红细胞沉降率（ESR）水平[（52．13±1．87）mm／1h比（22．78±1．43）mm／1h]均较轻症MPP组显著升高，差异均有统计学意义（t=6．511、3．342、2．891、8．075、7．922，均P〈0．05）；2．重症MPP组血清TLR4（1．53±0．12比0．45±0．07）、MyD88（1．28±0．10比0．37±0．12）和NF-KB（1．49±0．16比0．53±0．10）表达均较轻症MPP组上调，差异均有统计学意义（t=3．511、7．614、8．122，均P〈0．05）；3．影像学表现为肺实变（46例）、肺不张（17例）、胸腔积液（29例）的患儿血清D一二聚体水平、TLR4、MyD88和NF-KB表达均较无相关表现者升高，差异均有统计学意义（均P〈0．05）；4．有肺外并发症13例患儿血清D-二聚体水平[（2984．19±138．43）μg/L比（640．48±78．89）μg／L]、TLtl4（2．53±0．41比0．92±0．17）、MyD88（2．18±0．12比0．57±0．06）和NF-KB（2．47±0．16比0．89±0．15）表达均较无肺外并发症组高，差异均有统计学意义（t=6．148、5．614、5．876、7．318，均P〈0．01）。结论重症MPP患儿血清中TLR4/My088表达的增加与D-二聚体水平的升高呈一致性，提示TLR4／MyD88信号通路的激活可能参与了重症NPP患儿血液高凝状态的形成过程。

Objective To explore the clinical significance of serum Toll - like receptor 4 （TLR4）/Myeloid differentiation factor 88 （ MyD88 ） and D - dimer level detection in children with serious Mycoplasma pneumoniae pneu- monia（MPP）. Methods Ninety cases of MPP hospitalized children from June 2015 to December 2016 at Affiliated Hospital of Xuzhou Medical College were divided into serious MPP group （42 cases） and mild MPP group （48 cases） according to the severity of their illness. The level of serum D - dimer was detected by immune turhidimetry, and the ex- pressions of TLR4, MyD88 and nuclear factor - KB （ NF - KB） were detected by Western blot. Results （ 1 ） The level of D - dimer [ （ 1 850. 12 ± 153.50） μg/L vs. （297.36± 27.42 ） μg/L ] , white blood counts （WBC） E （ 11.52 ± 0.38） x 109/L vs. （7.98± 0.62） x 109/L ], neutrophile granulocyte ratio （N） （ 0.87± 0.01 vs. O. 55± 0.01 ）, C - reactive protein （CRP） [ （64.59 ± 7.93 ） mg/L vs. （ 19.79 ± 6.38 ） mg/L ] , as well as erythrocyte sedimentation rate （ESR） [ （52.13 ± 1.8 ） mm/1 h vs. （22.78 ±1.43 ） mm/1 hi in the serious MPP group were higher than those in the mild MPP group, and the differences were statistically significant （ t = 6.511,3. 342,2.891,8. 075,7. 922, all P 〈 0.05）.（2）TheexpressionofTLR4 （1.53±0.12 vs. 0.45 ± 0. 07 ） , MyD88 （1.28±0.10 vs. 0.37±0.12） and NF - KB （ 1.49 ± 0.16 vs. O. 53± 0.10） in the serious MPP group were higher than those in the mild MPP group, and the differences were statistically significant （ t=3.511,7.614,8. 122, all P 〈 0.05 ）. （ 3 ） The D - dimer levels, TLR4, MyD88 and NF- KB of the cases who had the image feature of lung patchy shadow （46 cases） , atelectasis （17 cases） and pleural effusion （29 cases ）, were obviously higher than those who had not, and the differences were statistically sig- nificant（all P 〈0.05）. （4） The plasma D - dimer levell （2 984.19 ± 138.43） μg/L vs. （640.48±78.89） μg/L] and expressions of TLR4（2.53 ±0.41 vs. 0.92 -0.17） ,MyD88（2.18±0. 12 vs. 0.57±0.06） ,NF - KB（2.47 ± 0.16 vs. O. 89 ± 0. 15 ） in the cases with extrapulmonary complications （13 cases） were higher than those without extrapulmonary complications, and the differences were statistically significant （ all P 〈 0.01 ）. Conclusion The expre- ssion of TLR4/MyD88 increased in consistent with the up - regulation of D - dimer level in children with serious MPP,which indicated that the TLR4/MyD88 signaling pathway may participate in the formation of hypercoagulable state of children with serious MPP.