下呼吸道肺炎支原体感染对患儿肺功能与血清NO水平及Th1/Th2平衡的影响研究

Influence of lower respiratory tract Mycoplasma pneumoniae infection on pulmonary function,serum NO level and Th1/Th2 balance of children

目的探讨下呼吸道肺炎支原体感染患儿肺功能、血清一氧化氮(NO)水平及Th1/Th2平衡的变化情况。方法选择2018年1月-2019年3月连云港市中医院儿科收治的肺炎支原体肺炎患儿89例作为研究对象,根据患儿是否存在哮鸣音将其分为喘息组患儿48例、非喘息组患儿41例,选择同期医院儿科健康体检儿童50名作为对照组。观察肺炎支原体肺炎患儿急性期和对照组体检受试儿童肺功能指标一秒用力呼气容积(Forced expiratory volume in one second, FEV_1)、用力肺活量(Forced vital capacity, FVC)、峰值呼气流量(Peak expiratory flow, PEF),血管活性物质血清NO水平以及细胞因子血清干扰素-γ(INF-γ)和白细胞介素-4(IL-4)水平。结果肺炎支原体肺炎喘息组患儿肺功能指标FEV_1、FEV_1/FVC和PEF水平分别为(73.41±7.38)%、(71.46±4.72)%和(74.62±6.30)%均显著低于非喘息组和对照组(P<0.05);肺炎支原体肺炎喘息组患儿血清NO水平(87.39±7.01)μmol/L显著高于非喘息组和对照组(P<0.05);肺炎支原体肺炎喘息组患儿IFN-γ和IL-4水平为(980.67±125.73)ng/L和(678.49±93.92)ng/L均较非喘息组和对照组显著升高(P<0.05),IFN-γ/IL-4较非喘息组和对照组显著降低(P<0.05)。Pearson相关性分析结果,血清NO、IFN-γ、IL-4与肺功能指标FEV_1、FEV_1/FVC、PEF呈显著负相关关系(P<0.05),IFN-γ/IL-4与肺功能指标呈显著正相关关系(P<0.05)。结论肺炎支原体肺炎患儿肺功能降低、血清NO水平升高且存在明显的免疫失衡状态,其中出现喘息症状的患儿上述变化更加明显,血清NO水平以及Th1/Th2免疫平衡状态均与肺炎支原体肺炎患儿疾病发生发展密切相关,且与患儿喘息发生以及疾病进一步诱导哮喘发生有关,值得进一步深入研究分析。

OBJECTIVE To explore the changes of pulmonary function,serum NO level and Th1/Th2 balance of the children with lower respiratory tract Mycoplasma pneumoniae infection.METHODS Totally 89 children with M.pneumoniae pneumonia who were treated in the Department of Pediatrics of Lianyungang Traditional Chinese Medicine Hospital from Jan 2018 to Mar 2019 were recruited as the study objects and divided into the wheezing group with 48 cases and the non-wheezing group with 41 cases according to the presence of wheezing,meanwhile,50 healthy children who received physical examination in the department of pediatrics were set as the control group.The forced expiratory volume in one second(FEV1),forced vital capacity(FVC),peak expiratory flow(PEF)and vasoactive substance serum nitric oxide(NO)as well as cytokines serum interferon-γ(INF-γ)and interleukin-4(IL-4)of the children with M.pneumoniae pneumonia in acute stage and the children of the control group were observed.RESULTS The levels of pulmonary function indexes FEV1,FEV1/FVC and PEF of the wheezing group were respectively(73.41±7.38)%,(71.46±4.72)%and(74.62±6.30)%,significantly lower than those of the non-wheezing group and the control group(P<0.05).The serum NO level of the wheezing group was(87.39±7.01)μmol/L,significantly higher than that of the non-wheezing group and the control group(P<0.05).The levels of IFN-γand IL-4 of the wheezing group were respectively(980.67±125.73)ng/L and(678.49±93.92)ng/L,significantly higher than those of the non-wheezing group and the control group(P<0.05).The IFN-γ/IL-4 of the wheezing group was significantly lower than that of the non-wheezing group and the control group(P<0.05).Pearson correlation analysis showed that the serum NO,IFN-γand IL-4 were negatively correlated with the pulmonary function indexes FEV1,FEV1/FVC and PEF(P<0.05),and the IFN-γ/IL-4 was positively correlated with the pulmonary function indexes(P<0.05).CONCLUSION The children with M.pneumoniae pneumonia have the decline of lung function,rise of serum NO level and remarkable immune imbalance,and the above changes are more obvious in the children with wheezing symptom.The serum NO level and Th1/Th2 immune balance are closely associated with the occurrence and development of diseases in the children with M.pneumoniae pneumonia and is related to the occurrence of wheezing and the further induction of asthma,which is worthy to be further studied.