儿童普通及难治性支原体肺炎维生素A水平及免疫功能的临床分析

Analysis on the vitamin A level and immune function in children with common and refractory mycoplasma pneumoniae pneumonia

目的:探讨儿童普通支原体肺炎(MPP)及难治性MPP(RMPP)的维生素A水平及免疫功能。方法:选取2017年3月至2018年8月河北省沧州市人民医院儿科收治的MPP患儿300例,分为MPP组(220例)和RMPP组(80例)。比较两组年龄、性别、临床症状、C反应蛋白(CRP)、白介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α、干扰素(IFN)-γ、维生素A、胸片结果。采用逐步Logistic回归分析法分析RMPP影响因素。结果:两组性别、肺部啰音、咳嗽发生率、血清IgG、IgM、TNF-α、累及双侧肺的检出率比较,差异无统计学意义(P>0.05);RMPP组年龄、高热发生率、维生素A缺乏(CVAD)和亚临床维生素A缺乏(SVAD)发生率、血清CRP、IgA、IL-6、IL-10、IFN-γ、胸腔积液、胸膜增厚、大叶性肺不张、肺大片实变影检出率与MPP组比较,差异均有统计学意义(均P<0.05)。高热、CVAD、SVAD、血清CRP、IL-6、IL-10、IFN-γ、IgA、大叶性肺不张、肺大片实变影是RMPP的影响因素(P<0.05)。结论:MPP患儿存在持续高热、胸片示肺部大片实变影、大叶性肺不张,血清CRP、IL-6、IL-10、IFN-γ水平升高明显、CVAD、SVAD时,应警惕RMPP可能。

Objective:To observe the vitamin A level and immune function in children with mycoplasma pneumoniae pneumonia(MPP)and refractory MPP(RMPP).Methods:A total of 300 children with MPP treated in our hospital from March 2017 to August 2018 were divided into MPP group(220 cases)and RMPP group(80 cases).The age,gender,clinical symptoms,C-reactive protein(CRP),interleukin(IL)-6,IL-10,tumor necrosis factor(TNF)-α,interferon(IFN)-γand vitamin A levels as well as X-ray chest examination results were compared between two groups.Stepwise logistic regression analysis was used to determine the influencing factors of RMPP.Results:There were no significant differences in gender,the incidence of lung rale and cough,the serum IgG,IgM and TNF-αlevels and the detection rate of bilateral lung involvement between the two groups(P>0.05).The age,the incidence of high fever,clinical vitamin A deficiency(CVAD)and subclinical vitamin deficiency(SVAD),and the serum CRP,IL-6,IL-10 and IFN-γlevels as well as the detection rate of pleural effusion,pleural thickening,lobar arrhythmia and lung lung large smear in RMPP group were higher than those in MPP group(P<0.05).Hyperthermia,CVAD,SVAD,CRP,IL-6,IL-10,IFN-γ,IgA,lobar arrhythmia,and lung enlargement were the factors influencing RMPP(P<0.05).Conclusion:Children with MPP had sustained high fever,and a chest X-ray showing large lobar atelectasis,elevated serum CRP,IL-6,IL-10 and IFN-γlevels,CVAD and SVAD should be considered as RMPP.