肺炎支原体混合EB病毒感染的临床免疫特征分析

Clinical and immunological characteristics of Mycoplasma pneumoniae complicated with Epstein-Barr virus infection

目的探讨肺炎支原体(MP)混合EB病毒(EBV)感染后大叶性肺炎患儿临床特征及免疫功能的变化。方法选取2017年1月至2018年12月在西安市中心医院和西安市儿童医院确诊的99例大叶性肺炎患儿,按感染情况分为:MP混合EBV感染组(组1)24例、MP感染无EBV感染组(组2)40例、无MP和EBV感染组(组3)35例。比较分析三组患儿的热退时间、并发症情况、影像学恢复时间及住院时间,以及血清免疫球蛋白和淋巴细胞亚群的变化情况。结果三组的年龄、热退时间、影像学恢复时间及住院时间比较差异均有统计学意义(F值分别为3.293、10.938、3.852、8.542,P<0.05)。三组的并发症发生率比较差异有统计学意义(χ^(2)=10.993,P<0.05);在所有出现的并发症中,呼吸系统并发症发生率最高(92.31%),其次为脏器损害(46.15%),第三为血液系统损害(11.54%),未发现神经系统损害。三组的IgM水平比较差异有统计学意义(F=13.865,P<0.05);三组的CD8^(+)、CD4^(+)、CD4^(+)/CD8^(+)、T淋巴细胞、B淋巴细胞、NK细胞水平比较差异均有统计学意义(F值分别为6.397、5.948、23.064、4.414、5.902、3.213,P<0.05)。结论在支原体感染的大叶性肺炎中,如果治疗时间长、发热时间长、出现并发症等表现,需警惕混合EBV感染,尤其在小年龄患儿中需要予以考虑。支原体及EBV感染,对儿童体液免疫及细胞免疫功能均有影响。对于存在难治性或治疗效果不好的大叶性肺炎患儿,应警惕存在支原体及EBV感染可能导致的疾病迁延。

Objective To investigate changes of the clinical characteristics and immune function of patients with lobar pneumonia af-ter infecting with Mycoplasma pneumoniae(MP)and the Epstein-Barr virus(EBV).Methods 99children diagnosed with lobar pneumonia in Xi′an Central Hospital and Xi′an Child Hospital from January 2017to December 2018were selected,and divided into three groups according to infection:MP infection with EBV infection(group 1,24cases),MP infection without EBV infection(group 2,40cases)and no MP and no EBV infection(group 3,35cases).The time of fever recede,complications,imaging recovery time,hospitalization time,serum level of immunoglobulin,and lymphocyte subsets of the three groups were compared.Results The age,time of fever recede,imaging recovery time and hospitalization time were statistically significant in the three groups(F=3.293,10.938,3.852,and 8.542,respectively,P<0.05).There was a significant difference in the incidence of complications in the three groups(χ^(2)=10.993,P<0.05).In all complications,the incidence of respiratory complications was the highest(92.31%),followed by organ damage(46.15%),the third was hematologic system damage(11.54%),and no nervous system damage was found.There was a statistically significant difference in the three groups of immunoglobulin M(IgM)levels(F=13.865,P<0.05).The levers of CD8^(+),CD4^(+),CD4^(+)/CD8^(+),T lymphocytes,B lymphocytes,Natural-Killer(NK)cell had statistically signifi-cant in the three groups(F=6.397,5.948,23.064,4.414,5.902,and 3.213,P<0.05).Conclusion In lobar pneumonia infected with MP,if combined with long time of treatment and fever,and the generation of complications,EBV infection needs to be consid-ered,especially in young children.MP and EBV infection have affected children with body fluid immunization and cellular immune function.For lobar pneumonia with refractory or ineffective treatment,joint infection with MP and EBV may lead to a prolonged disease course.