血清D-二聚体、IL-6、IL-18对儿童难治性肺炎支原体肺炎的预测价值

Predictive value of serum D-Dimer,IL-6 and IL-18 for refractory mycoplasma pneumoniae pneumonia in children

目的:探讨血清D-二聚体、白细胞介素-6(interleukin 6,IL-6)、白细胞介素-18(interleukin 18,IL-18)对儿童难治性肺炎支原体肺炎(refractor ymycoplasmapneumoniaepneumonia,RMPP)的预测价值。方法:以2020年5月至2021年5月北京怀柔医院收治的150例肺炎支原体肺炎(mycoplasma pneumoniaepneumonia,MPP)患儿为研究对象,根据临床诊断标准将其分为RMPP组(n=52)与普通肺炎支原体肺炎(general mycoplasma pneumoniae pneumonia,GMPP)组(n=98),比较2组一般基础资料、胸部CT影像学资料及治疗前的血清指标[D-二聚体、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、肿瘤坏死因子-α(tumornecrosisfactor-α,TNF-α)、IL-6、IL-18]水平。采用logistic回归分析RMPP的独立影响因素,并绘制受试者工作特征(receiveroperator characteristic,ROC)曲线评估D-二聚体、IL-6、IL-18诊断RMPP的临床价值。结果:RMPP组患儿胸腔积液、肺实变、肺不张比例及血清D-二聚体、CRP、PCT、IL-6、IL-18水平显著高于GMPP组(P<0.05),2组一般基础资料、血清TNF-α水平比较,差异无统计学意义(均P>0.05)。Logistic回归分析显示:肺实变、胸腔积液、肺不张及血清D-二聚体、CRP、PCT、IL-6、IL-18表达升高是预测RMPP的独立危险因素(P<0.05)。ROC曲线显示:血清D-二聚体、IL-6、IL-18预测RMPP的曲线下面积分别为0.830、0.825、0.860,截断值分别为0.56 mg/L、24.96 pg/mL、393.51 pg/mL。结论:血清D-二聚体、IL-6、IL-18可作为儿童RMPP的早期预测指标。

Objective:To investigate the predictive value of serum D-Dimer,interleukin-6(IL-6)and interleukin-18(IL-18)on refractory mycoplasma pneumoniae pneumonia(RMPP)in children.Methods:A total of 150 children with mycoplasma pneumoniae pneumonia(MPP)admitted to our hospital from May 2020 to May 2021 were selected as the research subjects and divided into a RMPP group(n=52)and a general mycoplasma pneumoniae pneumonia(GMPP)group(n=98)according to the clinical diagnostic criteria.The general basic data,chest CT imaging data and serum indexes before treatment[D-Dimer,C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),IL-6,and IL-18]were compared between the 2 groups.Logistic regression was used to analyze the independent influencing factors of RMPP,and receiver operating characteristic curve(ROC)was drawn to evaluate the clinical value of D-Dimer,IL-6 and IL-18 in the diagnosis of RMPP.Results:The proportion of pleural effusion,pulmonary consolidation,atelectasis and serum levels of D-Dimer,CRP,PCT,IL-6 and IL-18 in RMPP group were significantly higher than those in the GMPP group(P<0.05).Logistic regression analysis showed Pulmonary consolidation,pleural effusion,atelectasis and increased expression of serum D-Dimer,CRP,PCT,IL-6 and IL-18 were independent risk factors for RMPP(P<0.05).ROC curve showed that the areas under the curve of serum D-Dimer,IL-6 and IL-18 for predicting RMPP were 0.830,0.825 and 0.860,respectively,and the cut-off values were 0.56 mg/L,24.96 pg/mL and 393.51 pg/mL,respectively.Conclusion:Serum D-Dimer,IL-6 and IL-18 can be used as early predictors of RMPP in children.