儿童难治性肺炎支原体肺炎的临床特征及其免疫指标分析

Clinical Features of Refractory Mycoplasma Pneumoniae Pneumonia in Children and Analysis of the Cellular Immune Related Indicators

目的:探讨儿童难治性肺炎支原体肺炎(RMPP)的临床特征及支气管肺泡灌洗液(BALF)中T淋巴细胞亚群、相关细胞因子、可溶性B7-H3(sB7-H3)表达情况。方法:选择2017年1月~2019年2月我院呼吸科收治的86例RMPP患儿纳入RMPP组,另择同期于我院治疗的100例普通支原体肺炎(MPP)患儿纳入MPP组。记录患儿的临床表现,测定BALF中T淋巴细胞亚群比例及IL-1β、IL-2、IL-6、IL-8、肿瘤坏死因子(TNF-α)、sB7-H3水平。结果:与MPP组比较,RMPP组患儿发热时间长(P<0.05);肺部呼吸音减弱、大面积肺实变/肺不张、胸腔积液比例较高(P<0.05);肺外心血管系统、消化系统及肝脏受累比例高(P<0.05);实验室检查C反应蛋白(CRP)、红细胞沉降率(ESR)水平升高(P<0.05);RMPP组BALF中CD3+、CD4+、CD4+/CD8+等指标水平均低于MPP组(P<0.05),CD8+水平高于MPP组(P<0.05);RMPP组患儿BALF中IL-1β、IL-2、IL-6、IL-8、TNF-α、sB7-H3等细胞因子水平均高于MPP组(P<0.05)。结论:RMPP患儿肺部临床表现及炎症浸润更为严重,临床可根据临床表现及BALF中免疫相关指标进行疾病诊断及严重程度的判别。

Objective:To investigate the clinical features of children with refractory mycoplasma pneumoniae pneumonia(RMPP)and the levels of T lymphocyte subsets,related cytokines and soluble B7-H3(sB7-H3)in bronchoalveolar lavage fluid(BALF).Methods:86 children with RMPP who were admitted to the department of respiratory from January 2017 to February 2019 were included in RMPP group.Another 100 children with common mycoplasma pneumoniae pneumonia(MPP)admitted in the hospital during the same period were included in MPP group.The clinical manifestations of all children were recorded.The proportion of T lymphocyte subsets in BALF and levels of interleukin(IL)-1β,IL-2,IL-6,IL-8,tumor necrosis factor(TNF-α)and sB7-H3 were detected.Results:Compared with those in MPP group,children in RMPP groups showed longer fever duration(P<0.05);higher incidences of decreased breath sounds,larger area of lung consolidation/atelectasis and more pleural effusion(P<0.05);higher incidences on the involvement of pulmonary extranuclear cardiovascular system,digestive system and liver(P<0.05);higher expression levels of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)determined by laboratory examinations(P<0.05).The levels of CD3+,CD4+,CD4+/CD8+in BALF of RMPP group were higher than those in MPP group(P<0.05).While the CD8+level in RMPP group was significantly lower than that in MPP group(P<0.05).The levels of cytokines IL-1β,IL-2,IL-6,IL-8,TNF-αand sB7-H3 in BALF of RMPP group were significantly higher than those in MPP group(P<0.05).Conclusion:The clinical manifestations and inflammatory infiltration of lungs in children with RMPP are more serious.The clinical diagnosis and severity of the disease can be judged according to clinical manifestations and cellular immune related indicators in BALF.