支原体肺炎伴喘息儿童肺功能、FeNO水平及Th1/Th2免疫平衡状态的变化

Analysis of changes in lung function,FeNO level and Th1/Th2 immune balance in children with mycoplasma pneumonia and wheezing

目的分析支原体肺炎伴喘息儿童肺功能、呼出气一氧化氮(FeNO)水平以及Th1细胞/辅助性Th2细胞(Th1/Th2)免疫平衡状态变化。方法选取2018年11月至2019年11月期间上海市普陀区人民医院支原体肺炎患儿60例作为观察组,并根据患儿的临床症状分为喘息组32例和非喘息组28例,选择同期于上海市普陀区人民医院体检健康的儿童30例作为对照组,比较三组儿童第一秒最大呼气容积(FEV_(1)%)、FEV_(1)与用力肺活量比值(FEV_(1)/FVC)、呼气峰值流速(PEF%)、FeNO、IFN-γ、IL-4、IFN-γ/IL-4的指标水平,并采用Pearson相关分析法分析FeNO、Th1细胞因子干扰素-γ(IFN-γ)、Th2细胞因子白细胞介素-4(IL-4)、IFN-γ/IL-4水平与FEV_(1)、FEV_(1)/FVC、PEF的相关性。结果喘息组患儿FEV_(1)、FEV_(1)/FVC、PEF水平明显低于非喘息组和对照组,非喘息组患儿FEV_(1)、FEV_(1)/FVC、PEF水平明显低于对照组,差异均有统计学意义(P<0.05);喘息组患儿FeNO、IFN-γ、IL-4水平明显高于非喘息组和对照组,非喘息组患儿FeNO、IFN-γ、IL-4水平明显高于对照组,而喘息组患儿的IFN-γ/IL-4明显低于非喘息组和对照组,非喘息组患儿IFN-γ/IL-4明显低于对照组,差异均有统计学意义(P<0.05);经Pearson相关分析结果显示,FeNO、IFN-γ、IL-4与FEV_(1)、FEV_(1)/FVC、PEF均呈负相关(P<0.05),IFN-γ/IL-4与FEV_(1)、FEV_(1)/FVC、PEF呈正相关(P<0.05)。结论支原体肺炎伴喘息儿童肺功能明显降低、血清FeNO水平升高,并伴有明显的Th1/Th2免疫失衡状态,且血清FeNO、Th1/Th2免疫失衡和肺功能之间密切相关,参与了病情的发生和发展。

Objective To analyze the changes in pulmonary function,fractional exhaled nitric oxide(FeNO)level and Th1/Th2 immune balance in children with mycoplasma pneumonia and wheezing.Methods Sixty children with mycoplasma pneumonia who were admitted to Shanghai Putuo District People's Hospital from November 2018 to November 2019 were selected as the observation group,and the children were divided into wheezing group(32 cases)and non-wheezing group(28 cases)according to the clinical symptoms.Thirty healthy children who underwent physical examination at the hospital during the same period were selected as the control group.The maximum rate of forced expiratory volume in the first second(FEV_(1)%)were compared between the three groups,as well as the ratio of FEV_(1) to forced vital capacity(FEV_(1)/FVC),peak expiratory flow rate(PEF%),and the levels of FeNO,IFN-γ,IL-4,and the ratio of IFN-γ/IL-4.Then Pearson correlation analysis method was used to analyze the correlation between FeNO,Th1 cytokine interferon-γ(IFN-γ),Th2 cytokine interleukin-4(IL-4),IFN-γ/IL-4 and FEV_(1),FEV_(1)/FVC,PEF.Results The levels of FEV_(1),FEV_(1)/FVC and PEF in the wheezing group were significantly lower than those in the non-wheezing group and the control group;and the above levels in the non-wheezing group were significantly lower than those in the control group(P<0.05).The levels of FeNO,IFN-γand IL-4 in the wheezing group were significantly higher than those in the non-wheezing group and the control group,and these levels in the non-wheezing group were significantly higher than those in the control group;while the ratio of IFN-γ/IL-4 in the wheezing group was significantly lower than that in the non-wheezing group and the control group,and the IFN-γ/IL-4 in the non-wheezing group was significantly lower than that in the control group(P<0.05).Pearson correlation analysis showed that FeNO,IFN-γ,IL-4 were all negatively correlated with FEV_(1),FEV_(1)/FVC,and PEF(P<0.05).IFN-γ/IL-4 was positively correlated with FEV_(1),FEV_(1)/FVC and PEF(P<0.05).Conclusion Children with mycoplasma pneumonia and wheezing have significantly reduced lung function and increased serum FeNO levels with significant Th1/Th2 immune imbalance.Serum FeNO and Th1/Th2 immune imbalance was closely related to lung function,and they are involved in the occurrence and development of the disease.