血清及肺泡灌洗液γ干扰素、血栓素和可溶性B7-H3在难治性肺炎支原体肺炎中的鉴别诊断价值分析

Diagnostic value of serum and alveolar lavage fluid interferon-γ,thrombin and soluble B7-H3 in the treatment of refractory mycoplasma pneumoniae

目的探究血清及肺泡灌洗液γ干扰素(IFN-γ)、血栓素(TXB2)、可溶性B7-H3(sB7-H3)在难治性肺炎支原体肺炎(RMPP)病儿中的表达水平及鉴别诊断价值。方法选择2017年2月至2019年3月于郑州大学附属儿童医院住院治疗的80例RMPP病儿、80例普通支原体肺炎(MPP)病儿及50例查体健康儿童作为研究对象,分别纳入RMPP组、MPP组及对照组。收集临床症状,测定血清及肺泡灌洗液IFN-γ、TXB2和sB7-H3水平。结果RMPP组病儿肺部呼吸音减低、肺实变、胸腔积液、黏膜糜烂、黏液栓形成等发生率显著高于MPP组(P<0.05);RMPP组、MPP组病儿血清IFN-γ[(895.63±212.96)、(624.85±158.96)pg/mL]、TXB2[(289.28±89.56)、(195.17±79.63)pg/mL]和sB7-H3[(466.71±127.45)、(312.48±105.71)pg/mL]水平显著高于对照组[(104.12±31.02)、(35.85±12.45)、(44.15±15.74)pg/mL](P<0.05),RMPP组血清各指标水平高于MPP组(P<0.05);RMPP组病儿肺泡灌洗液中IFN-γ[(89.46±34.12)、(45.78±10.27)pg/mL]、TXB2[(88.45±32.78)、(54.17±17.48)pg/mL]和sB7-H3[(142.51±44.78)、(107.48±34.71)pg/mL]水平均显著高于MPP组(P<0.05);血清IFN-γ、sB7-H3水平与病儿胸腔积液、肺实变发生相关(P<0.05);血清TXB2、肺泡灌洗液IFN-γ、TXB2、sB7-H3水平与肺部呼吸音减低、肺实变、胸腔积液、黏液栓形成等发生相关(P<0.05);ROC曲线分析示,肺泡灌洗液TXB2诊断RMPP的曲线下面积最大,诊断截点值为68.59 pg/mL,诊断灵敏度及特异度分别为85.0%、78.7%。结论与MPP比较,RMPP病儿血清及肺泡灌洗液IFN-γ、TXB2和sB7-H3的水平明显升高,肺泡灌洗液TXB2诊断RMPP的诊断效能最高。

Objective To investigate the expression levels of interferon-γ(IFN-γ),thromboxane(TXB2)and soluble B7-H3(sB7-H3)in serum and bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia(RMPP)and their diagnostic value.Methods Eighty children with RMPP who were hospitalized in Children’s Hospital Affiliated to Zhengzhou University from February 2017 to March 2019 and 80 children with common MPP were selected as subjects.They were enrolled in RMPP group and MPP group,respectively.Clinical symptoms were collected,and levels of IFN-γ,TXB2 and sB7-H3 in serum and bronchoalveolar lavage fluid were determined.ResultsThe incidence rates of reduced lung breath sounds,lung consolidation,pleural effusion,mucosal erosion and mucus plug formation were significantly higher in RMPP group than in MPP group(P<0.05).The levels of IFN-γ[(895.63±212.96),(624.85±158.96)pg/mL],TXB2[(289.28±89.56),(195.17±79.63)pg/mL]and sB7-H3[(466.71±127.45),(312.48±105.71)pg/mL]in serum in RMPP group and MPP group were significantly higher than those in control group[(104.12±31.02),(35.85±12.45),(44.15±15.74)pg/mL](P<0.05).The serum levels of RMPP group were higher than those in MPP group(P<0.05).Levels of IFN-γ[(89.46±34.12),(45.78±10.27)pg/mL],TXB2[(88.45±32.78),(54.17±17.48)pg/mL]and sB7-H3[(142.51±44.78),(107.48±34.71)pg/mL]in bronchoalveolar lavage fluid of RMPP group were significantly higher than those in MPP group(P<0.05).Serum levels of IFN-γand sB7-H3 were correlated with the occurrence of pleural effusion and lung consolidation(P<0.05).Levels of serum TXB2 and IFN-γ,TXB2 and sB7-H3 in bronchoalveolar lavage fluid were correlated with the occurrence of reduced lung breath sounds,lung consolidation,pleural effusion and mucus plug formation(P<0.05).ROC curve analysis showed that the area under the curve of TXB2 in bronchoalveolar lavage fluid was the largest,and the diagnostic cut-off value was 68.59 pg/mL.The diagnostic sensitivity and specificity were 85.0%and 78.7%,respectively.ConclusionCompared with children with MPP,levels of IFN-γ,TXB2 and sB7-H3 are significantly increased in serum and bronchoalveolar lavage fluid of children with RMPP.The diagnostic efficiency of TXB2 in bronchoalveolar lavage fluid is the highest.