肺炎支原体肺炎患儿免疫功能的变化及意义

Changes and clinical significance of immune function and cytokines in children patients with mycoplasma pneumoniae pneumonia

目的探讨肺炎支原体肺炎(MPP)患儿免疫功能(包括血清免疫球蛋白、外周血T淋巴细胞亚群CD+4、CD+8、CD+3、CD+4/CD+8)、血清乳酸脱氢酶(LDH)和白介素-18(IL-18)水平的变化及其与病情严重程度和疾病分期的关系,为重症肺炎支原体肺炎寻找早期诊断的炎性标记物。方法选取确诊为MPP的202例住院患儿为研究对象,根据病情程度分为普通组100例及重症组102例,选取支气管异物患儿为对照组。MPP患儿在治疗第1天及治疗后15d空腹抽取静脉血,检测血清免疫球蛋白A(IgA)、IgM、IgG,外周血T淋巴细胞亚群CD4^+、CD^+8、CD3^+、CD4^+/CD8^+水平、血清IL-18及LDH水平,比较3组检测结果。结果重症组和急性期患儿各项指标均与对照组有不同程度的差异,重症组与普通组患儿之间、急性期与恢复期患儿各指标均存在不同程度差异,差异有统计学意义(P<0.05)。重症MPP组LDH明显高于普通组及对照组(P<0.01),普通组及对照组LDH水平差异无统计学意义(P>0.05)。感染MPP组无论普通组还是重症组IL-18均较对照组显著增高,重症组较普通组IL-18水平显著降低,差异有统计学意义(P<0.05)。结论MPP患儿均有不同程度的体液免疫和细胞免疫功能紊乱,并且急性期和病情较重的患儿机体免疫功能紊乱越严重,患儿血清免疫成分浓度的变化可反映病情严重程度和疾病分期。LDH、IL-18水平的升高与MPP的严重程度相关,其病情越重,LDH水平越高,可作为重症MPP早期识别标志。

Objective To investigate the changes and clinical significance of immune function and cytokines levels in children with mycoplasma pneumoniae pneumonia(MPP)and its correlation with disease severity and staging in order to look for the inflammatory markers for early diagnosis of severe mycoplasma pneumoniae pneumonia.Methods A total of 202 children patients with MPP who were treated in our hospital were enrolled as research objects.According to the degree of illness,these patients were divided into mild case group(n=100)and severe case group(n=102),moreover,the children patients with bronchial foreign body were enrolled as control group.The serum levels of immune globulin A(IgA),IgM,IgG,T lymphocyte subgroups(CD4^+,CD8^+,CD3^+,CD4^+/CD8^+)in peripheral blood,IL-18 and actate dehydrogenase(LDH)were detected and compared among the three groups.Results There were significant differences in these indexes between mild case group and severe case group,and between the severe patients in acute stage and the patients in convalescence stage(P<0.05).Moreover the LDH levels in severe case group were significantly higher than those in mild case group and control group(P<0.01),however,there were no significant differences between mild case group and control group(P>0.05).The IL-18 levels in both mild case group and severe case group were significantly higher than those in control group(P<0.01),however,which in both mild case group and severe case group were significantly higher than those in control group(P<0.01),however,which in severe case group were significantly lower than those in mild case group(P<0.05).Conclusion The children with MPP have different degrees of disorder of humoral immunity and cellular immune function,moreover,the body immune dysfunction is more severe in severe cases and the cases in acute stage.The changes of serum concentration can reflect the disease severity and staging,therefor,which can be regarded as the early markers in diagnosis of severe MPP.