血清和肽素、Toll样受体2、Toll样受体4水平与肺炎支原体感染所致重症肺炎患儿的病情、预后的关系探讨

Study on relationship between serum copeptin, TLR2 and TLR4 levels and condition and prognosis of severe pneumonia caused by mycoplasma pneumoniae infection in children

目的探讨血清和肽素(copeptin)、Toll样受体2(TLR2)、Toll样受体4(TLR4)水平与小儿肺炎支原体感染所致重症肺炎病情、预后的关系。方法选取2016年2月—2019年4月佛山市妇幼保健院收治的361例肺炎支原体感染所致重症肺炎患儿的临床资料进行回顾分析,另回顾同时间段体检中心接收的肺炎支原体感染所致的轻症肺炎患儿(105例)、健康婴幼儿童(82例)的资料,分别记为重症组、轻症组和健康组;并将重症组患儿根据小儿危重病例评分(PCIS)分为A组(小于70分)、B组(71~80分)、C组(大于80分)。对比各组患儿的血清和肽素、TLR2和TLR4水平;重症组患儿PCIS评分与血清和肽素、TLR2和TLR4水平的关系;重症组不同预后患儿血清和肽素、TLR2和TLR4水平;血清和肽素、TLR2和TLR4水平对重症组预后的预测效能。结果 A组、B组和C组、轻症组血清和肽素、TLR2和TLR4水平均高于健康组(P<0.05);A组、B组和C组血清和肽素、TLR2和TLR4水平均高于轻症组(P<0.05);且A、B、C 3组间的血清和肽素、TLR2和TLR4水平对比差异均有统计学意义(P<0.05)。重症组所选患儿PCIS评分与血清和肽素、TLR2和TLR4水平均呈负相关,相关系数分别为-0.831、-0.885、-0.907(P<0.05)。重症组死亡率为6.09%(22/361),存活患儿血清和肽素、TLR2和TLR4水平均低于死亡患儿(P<0.05)。血清和肽素、TLR2和TLR4水平预测小儿重症肺炎的最佳截断点分别为1.85、11.55、7.18 ng/mL,三者联合的灵敏度、特异度、AUC分别为90.91%、97.87%、0.869。结论小儿肺炎支原体感染所致的重症肺炎患儿血清和肽素、TLR2和TLR4水平普遍偏高,建议在肺炎支原体感染所致的重症肺炎患儿治疗中定期检测血清和肽素、TLR2和TLR4水平的动态变化,评估病情和生理状态,指导治疗,预测近期预后。

Objective To explore the relationship between the levels of serum copeptin, TLR2, TLR4 and the condition and prognosis of severe pneumonia caused by Mycoplasma pneumoniae infection in children. Methods The clinical data of 361 children with severe pneumonia admitted to Foshan Women Children Hospital from February 2016 to April 2019 were reviewed. In addition,the data of children with mild pneumonia(105 cases) and healthy children(82 cases) were received by the physical examination center in the same period were reviewed. The above patients were classified as severe group, mild group, and healthy group. And the children in the severe group were divided into group A(≤70 points), group B(71—80 points) and group C(> 80 points) according to the PCIS. Serum levels of copeptin, TLR2, and TLR4 were compared in each group. The relationship between PCIS score and serum levels of copeptin, TLR2 and TLR4;serum levels of copeptin, TLR2, and TLR4 in children with different prognosis in the severe group;and efficacy of serum copeptin, TLR2 and TLR4 levels in predicting prognosis of severe patients were compared.Results The serum levels of copeptin, TLR2 and TLR4 in group A, B, C and the mild disease group were all higher than those in the healthy group(P < 0.05). Serum levels of copeptin, TLR2 and TLR4 in group A, B and C were all higher than those in the mild group(P < 0.05). The serum levels of Copeptin, TLR2 and TLR4 were significantly different among groups A, B and C(P < 0.05). The PCIS scores of children in the severe disease group were negatively correlated with serum copeptin, TLR2 and TLR4 levels, and the correlation coefficients(r) were-0.831,-0.885, and-0.907, respectively(P < 0.05). The mortality rate in the severe group was6.09%(22/361), and the serum levels of copeptin, TLR2 and TLR4 in the surviving children were all lower than those in the dead children(P < 0.05). The best cut-off points of serum copeptin, TLR2, and TLR4 levels for predicting severe pneumonia in children were 1.85 ng/mL, 11.55 ng/mL, and 7.18 ng/mL, respectively. The sensitivity, specificity and AUC of the combination were 90.91%,97.87%, and 0.869, respectively. Conclusion The serum levels of copeptin, TLR2 and TLR4 in children with severe pneumonia caused by mycoplasma pneumoniae infection are generally high. It is suggested that the dynamic changes of serum levels of copeptin,TLR2 and TLR4 should be regularly detected in the treatment of children with severe pneumonia caused by mycoplasma pneumoniae infection, so as to assess the condition and physiological status, guide the treatment and predict the recent prognosis.