肺炎支原体肺炎患儿外周血CCL2、CCL4、CXCL8、CXCL9水平与心肌损伤的关系

Relationships Between the Levels of CCL2,CCL4,CXCL8 and CXCL9 in Peripheral Blood and Myocardial Injury in Children with Mycoplasma Pneumoniae Pneumonia

目的探讨肺炎支原体肺炎(MPP)患儿外周血单核细胞趋化蛋白1(MCP-1/CCL2)、巨噬细胞炎性蛋白1β(MIP-1β/CCL4)、CXC趋化因子配体8(CXCL8)、CXC趋化因子配体9(CXCL9)水平变化及其与心肌损伤的关系。方法选取2018年3月—2019年5月收治的72例MPP患儿为研究对象,根据患儿疾病严重程度分为MPP轻症组54例与MPP重症组18例;选取同期门诊体检健康儿童35例为对照组。检测各组外周血CCL2、CCL4、CXCL8、CXCL9水平以及血清急性时相蛋白指标水平。根据MPP患儿是否发生心律失常分为心律失常组12例与非心律失常组60例并检测其心肌酶谱指标。采用Pearson法分析CCL2、CCL4、CXCL9、CXCL8与MPP患儿血清急性时相蛋白指标及其与心律失常患儿心肌酶谱指标的相关性。结果MPP轻症组和MPP重症组血清CCL2、CCL4、CXCL8、CXCL9、C-反应蛋白(CRP)、α1-酸性糖蛋白(α1-AGP)、触珠蛋白(HP)、铜蓝蛋白(CP)水平均显著高于对照组,且MPP重症组显著高于MPP轻症组(P<0.05)。CCL2、CCL4均与CRP、α1-AGP、HP、CP呈正相关(P<0.05或P<0.01),CXCL8、CXCL9均与CRP、α1-AGP呈正相关(P<0.05或P<0.01),CXCL9与CP呈正相关(P<0.05)。心律失常组血清CCL2、CCL4、CXCL8、CXCL9、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDB)、磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)水平均显著高于非心律失常组(P<0.05或P<0.01)。CCL2、CXCL8、CXCL9均与LDH、α-HBDB、CK、CK-MB呈正相关(P<0.05或P<0.01),CCL4与LDH、α-HBDB、CK-MB呈正相关(P<0.05)。结论MPP患儿外周血CCL2、CCL4、CXCL8、CXCL9水平均明显升高,并与疾病严重程度及心肌损伤有关,对MPP病情评估及治疗方案的制定均具有重要意义。

Objective To investigate the changes of monocyte chemoattractant protein 1(MCP-1/CCL2),macrophage inflammatory protein 1β(MIP-1β/CCL4),C-X-C motif chemokine ligand 8(CXCL8),and C-X-C motif chemokine ligand 9(CXCL9)levels in peripheral blood of children with mycoplasma pneumoniae pneumonia(MPP)and their relationships with myocardial injury.Methods Seventy-two children with MPP admitted from March 2018 to May 2019 were selected as the research subjects.According to the disease severity,the children were divided into mild MPP group(n=54)and severe MPP group(n=18);35 healthy children who underwent physical examination in outpatient department during the same period were selected as the control group.The levels of CCL2,CCL4,CXCL8,CXCL9 and serum acute phase protein indexes in peripheral blood were detected in each group.The children with MPP were divided into arrhythmia group(n=12)and non-arrhythmia group(n=60)according to presence or absence of arrhythmia,and the myocardial enzyme spectrum indexes were measured.Pearson method was used to analyze the correlations of CCL2,CCL4,CXCL9,CXCL8 with serum acute phase protein indexes of children with MPP and myocardial enzyme spectrum indexes of children with arrhythmia.Results Serum levels of CCL2,CCL4,CXCL8,CXCL9,C-reactive protein(CRP),α1-acid glycoprotein(α1-AGP),haptoglobin(HP),and ceruloplasmin(CP)were significantly higher in mild MPP and severe MPP groups than in the control group,and the levels in severe MPP group were significantly higher than those in mild MPP group(P<0.05).CCL2 and CCL4 were positively correlated with CRP,α1-AGP,HP,and CP(P<0.05 or P<0.01),CXCL8 and CXCL9 were positively correlated with CRP andα1-AGP(P<0.05 or P<0.01),and CXCL9 was positively correlated with CP(P<0.05).Serum CCL2,CCL4,CXCL8,CXCL9,lactate dehydrogenase(LDH),α-hydroxybutyrate dehydrogenase(α-HBDB),creatine kinase(CK),and creatine kinase isoenzyme-MB(CK-MB)levels were significantly higher in arrhythmia group than in non-arrhythmia group(P<0.05 or P<0.01).CCL2,CXCL8 and CXCL9 were positively correlated with LDH,α-HBDB,CK and CK-MB(P<0.05 or P<0.01),and CCL4 was positively correlated with LDH,α-HBDB,and CK-MB(P<0.05).Conclusion The levels of CCL2,CCL4,CXCL8 and CXCL9 in peripheral blood of children with MPP are significantly increased,which are related to the severity of the disease and the occurrence of cardiac damage.Therefore it is of great significance to the evaluation of MPP and the formulation of therapeutic regimen.