儿童社区获得性肺炎病原体分析及对患儿T细胞水平的影响

Pathogen analysis of community acquired pneumonia in children and its effect on T cell level

目的:探讨儿童社区获得性肺炎病原体分析及对患儿T细胞水平的影响。方法:选择2015年5月～2017年10月入院治疗的儿童社区获得性肺炎患者248例,采用间接免疫荧光法(IFA)、被动凝集法、酶联免疫吸附试验(ELISA)法、胶体金法、细菌培养法联合检测常见呼吸道病原体。根据不同病原菌将患者分为肺炎支(衣)原体肺炎、病毒性肺炎、细菌性肺炎、混合感染性肺炎及不明原因肺炎。所有社区获得性肺炎患者入院后次日早晨均空腹采集静脉血3 ml,完成血清分离后采用ELISA测定IL-17、IL-10及转化生长因子β1(TGF-β1)水平;采用流式细胞仪测定入组患者CD3+、CD4+、CD8+及CD19+水平,分析儿童社区获得性肺炎病原菌构成比及对患儿T细胞水平的影响。结果:病原学检测结果表明:248例患者病原学检测排在前三位的分别为:MP、细菌、RSV,分别占:43. 55%、13. 71%和10. 89%。肺炎支(衣)原体肺炎、混合感染性肺炎IL-17、TGF-β1,均高于病毒性肺炎、细菌性肺炎、不明原因肺炎(P<0. 05)。肺炎支(衣)原体肺炎、混合感染性肺炎CD8+,均高于病毒性肺炎、细菌性肺炎级不明原因肺炎(P<0. 05)。肺炎支(衣)原体肺炎、混合感染性肺炎CD4+/CD8+,均低于病毒性肺炎、细菌性肺炎级不明原因肺炎(P<0. 05)。结论:儿童社区获得性肺炎中肺炎支(衣)原体肺炎占据比重较大,能引起机体炎症水平联级反应,降低患儿T细胞水平,应及时采取有效措施进行干预,促进患者恢复。

Objective:To investigate the pathogen of community acquired pneumonia in children and its effect on T cell level.Methods:248 children with community acquired pneumonia admitted to hospital from May 2015 to October 2017 were selected.Indirect immunofluorescence assay(IFA),passive agglutination assay,enzyme-linked immunosorbent assay(ELISA),colloidal gold assay and bacterial culture were used to detect common respiratory pathogens.According to different pathogenic bacteria,the patients were divided into three groups:mycoplasma pneumonia and chlamydia pneumonia,viral pneumonia,bacterial pneumonia,mixed infectious pneumonia and unexplained pneumonia.All patients with community acquired pneumonia were fasting to collect venous blood 3 ml the next morning after admission.After serum separation,the levels of IL-17,IL-10 and transforming growth factor-beta 1(TGF-β1)were measured by ELISA.The levels of CD3^+,CD4^+,CD8^+ and CD19^+ were measured by flow cytometry,and the children′s clubs were analyzed.Composition ratio of pathogenic bacteria of district acquired pneumonia and its effect on T cell level in children.Results:The results of etiological test showed that the top three pathogenic tests were MP,bacteria and RSV,accounting for 43.55%,13.71% and 10.89% respectively.The levels of IL-17 and TGF-β1 in chlamydia pneumonia and mixed infectious pneumonia were higher than those in viral pneumonia,bacterial pneumonia and unexplained pneumonia(P<0.05).The CD8^+ levels of mycoplasma pneumonia and chlamydia pneumonia and mixed infectious pneumonia were higher than those of viral pneumonia and bacterial pneumonia(P<0.05).The ratio of CD4^+/CD8^+ in mycoplasma pneumonia and chlamydia pneumonia and mixed infectious pneumonia was lower than that in viral pneumonia and bacterial pneumonia(P<0.05).Conclusion:Mycoplasma pneumonia and chlamydia pneumonia accounts for a large proportion in children with community acquired pneumonia.It can cause the level of inflammatory reaction and reduce the level of T cells in children.Effective measures should be taken to intervene in time to promote the recovery of patients.