儿童难治性肺炎支原体肺炎肺泡灌洗液IFN-γ/IL-4变化及MP-RNA表达

Changes of IFN-gamma/IL-4 and MP-RNA expression in bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia

目的探讨儿童难治性肺炎支原体肺炎肺泡灌洗液γ-干扰素(IFN-γ)/白介素-4(IL-4)变化及支原体核糖核酸(MP-RNA)表达。方法回顾性分析2017年6月-2018年6月难治性肺炎支原体肺炎(RMPP)和肺炎支原体肺炎(MPP)的住院患儿各30例;对照组取同期在本科因支气管异物行支气管镜下异物取出术的健康儿童30例,比较3组支气管肺泡灌洗液中IFN-γ、IL-4和IFN-γ/IL-4水平及MP-RNA表达。结果 BALF中IFN-γ和IL-4水平MPP组均高于对照组(t值分别为6. 01、11. 10,P <0. 01),而RMPP组高于MPP组(t值分别为4. 53、12. 37,P <0. 01)。3组咽部分泌物中MP-RNA阳性率比较,MPP组显著高于对照组(χ^2=58. 29,P <0. 01);MPP组、RMPP组与对照组比较,差异有统计学意义(χ^2值分别为38. 40、41. 71,P <0. 01);BALF中IFN-γ、IL-4、IFN-γ/IL-4与MP-RNA均呈正相关(r值分别为0. 55、0. 62、0. 61,P <0. 01)。结论 BALF中MP-RNA有助于早诊断MP感染,BALF中IFN-γ和IL-4水平均增高,且IFN-γ/IL-4越低越有助于早期识别RMPP。

Objective To observe the change of IFN-gamma( IFN-γ)/Interleukin-4( IL-4) and MP-RNA expression in bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia. Methods Each 30 children diagnosed as Mycoplasma pneumoniae pneumonia( MPP) and Mycoplasma pneumoniae pneumonia( RMPP) hospitalized in our ward from June 2017 to June 2018 were retrospectively analyzed. 30 healthy children who underwent bronchial foreign body removal under bronchoscopy in the same period were enrolled as the control group. Then the levels of interferon gamma( IFN-gamma),interleukin-4( IL-4) and MP-RNA expression in bronchoalveolar lavage fluid were compared among 3 groups.Results The levels of interferon gamma,interleukin-4 were significantly higher in the MPP group than in the control group( t = 6. 01,t = 11. 10,P 0. 01),while they were significantly higher in the RMPP group than in the MPP group( t = 4. 53,t = 12. 37,P 0. 01). The positive rate of MP-RNA in pharyngeal secretion were compared among 3 groups,which was significantly higher in the MPP group than in the control group(χ^2= 58. 29,P 0. 01). They were compared among the MPP group,RMPP group and the control group,there was statistical significance on the differences(χ^2= 38. 40,χ^2= 41. 71,P 0. 01). MP-RNA was positively correlated with IFN-gamma,IL-4 and the ratio of IFN gamma/IL-4( r = 0. 55,r = 0. 62,r = 0. 61,P 0. 01). Conclusion MP-RNA in bronchoalveolar lavage fluid is helpful for early diagnosis of MP infection.The increase of IFN-γ and IL-4 in bronchoalveolar lavage fluid,and the lower of the ratio of IFN gamma/IL-4 are helpful for early identification of refractory Mycoplasma pneumoniae pneumonia.