儿童社区获得性肺炎严重程度与血清细胞因子相关性研究

Study on the association between severity of community acquired pneumonia and serum cytokines in children

目的探讨社区获得性肺炎(community acquired pneumonia,CAP)患儿血清细胞因子与肺炎严重程度及其他基础辅助检测指标的相关性。方法回顾性分析重庆医科大学附属儿童医院2020年10月至2021年1月105例住院CAP患儿临床资料,并对整体样本及不同亚组内重症和非重症CAP组间血清细胞因子水平进行比较。结果重症组CAP组血清白细胞介素(IL)-6水平高于非重症组,但差异无统计学意义(14.98ng/L vs.4.2ng/L,P=0.581),而IL-2、IL-4、IL-10、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)及IL-17A水平在2组患儿间差异无统计学意义。不同病程亚组内,病程<14d组,重症CAP患儿血清IL-6水平明显高于非重症患儿,但差异无统计学意义(34.97ng/L vs.4.04ng/L,P=0.169);而病程≥14d组,重症与非重症CAP患儿血清IL-6水平无明显差异。相关性分析结果显示,仅在重症CAP亚组和病程<14d亚组,IL-6水平与C反应蛋白(CRP)呈显著正相关(r=0.521,P=0.008和r=0.467,P=0.000)。结论血清IL-6水平可作为较短病程CAP患儿病情严重程度的临床辅助指标,而对病程迁延或慢性病程者其临床参考价值待商榷。

Objective To investigate the correlation between serum cytokines and the severity of pneumonia and other laboratory variables in children with community-acquired pneumonia(CAP). Methods The clinical data of 105 children with CAP hospitalized in children’s Hospital affiliated to Chongqing Medical University from Oct. 2020 to Jan. 2021 were retrospectively analyzed, and serum cytokines were compared between severe and non-severe CAP in the whole sample and among different subgroups. Results In the whole sample, the serum IL-6 level of severe CAP was significantly higher than that of non-severe CAP,but with no statistically significance(14.98 ng/L vs. 4.2 ng/L,P=0.581). There were no statistical difference in serum levels of IL-2,IL-4,IL-10,TNF-α,IFN-γ or IL-17 A between severe and non-severe CAP patients. Among the subgroups of different disease course, in the early group(disease course<14 d),the IL-6 level of severe CAP was significantly higher than that of non-severe CAP,but with no statistically significantce(34.97 ng/L vs. 4.04 ng/L,P=0.169);while the IL-6 level in the later group(disease course≥14 d) was similar between severe CAP and non-severe CAP. The correlation analysis showed that IL-6 level was significantly positively correlated with CRP only in the severe CAP subgroup and the early subgroup(r=0.521,P=0.008 and r=0.467,P=0.000). Conclusion Serum IL-6 level can be used as an auxiliary clinical indicator to reflect the severity of CAP in children with short disease course, but the clinical reference value of IL-6 level in patients with prolonged or chronic disease course remains to be discussed.