肺炎支原体肺炎患儿血清补体C4和乳酸脱氢酶的测定及临床意义

Determination and clinical significance of serum complement C4 and LDH in children with MPP

目的探讨血清补体C4、乳酸脱氢酶(LDH)及α-羟丁酸脱氢酶(HBDH)等炎症指标对预测重症肺炎支原体肺炎发生风险的临床应用。方法回顾性收集2017年1月—2021年5月于绍兴市人民医院住院治疗的MPP患儿共70例,其中重症肺炎支原体肺炎(SMPP)30例(重症组)和普通肺炎支原体肺炎(MPP)40例(普通组),同期因矮小症和性早熟入住患儿45例作为对照组。比较3组患儿血清补体C4、LDH及HBDH水平等炎症指标的差异,同时应用受试者工作特征(ROC)曲线评价补体C4、LDH、HBDH及腺苷脱氨酶(ADA)对SMPP预测的诊断效能。结果重症组患儿补体C4、LDH、HBDH、LY、PA及ADA水平分别为(0.42±0.09)g/L、(375.66±87.64)U/L、(270.16±61.15)U/L、(1.38±0.46)×10~9/L、(88.01±27.33)mg/L及(23.54±4.70)U/L,普通组患儿补体C4、LDH、HBDH、LY、PA及ADA水平分别为(0.35±0.08)g/L、(268.87±37.42)U/L、(188.65±29.65)U/L、(1.95±0.60)×10~9/L、(114.36±29.86)mg/L及(19.34±3.41)U/L,对照组补体C4、LDH、HBDH、LY、PA及ADA水平分别为(0.26±0.07)g/L、(232.50±27.93)U/L、(172.45±21.58)U/L、(2.60±0.48)×10~9/L、(214.25±30.03)mg/L及(13.75±2.55)U/L。与对照组和普通组比较,重症组补体C4、LDH、HBDH及ADA水平均显著升高(均P<0.05),而淋巴细胞(LY)计数、前白蛋白(PA)水平则显著下降(均P<0.05);普通组与对照组比较,补体C4、LDH及ADA水平均显著升高(P<0.05),LY计数、PA水平显著下降(P<0.05),HBDH水平两组无显著差异(P>0.05);补体C4、LDH、HBDH及ADA预测SMPP发生风险的ROC曲线下面积分别为0.826(0.733,0.919)、0.962(0.932,0.993)、0.943(0.897,0.988)及0.878(0.813,0.943)。结论检测血清补体C4、LDH、HBDH、ADA、LY及PA有助于SMPP的早期诊断。

Objective To explore the clinical application of serum complement C4,LDH,HBDH and other inflammatory markers in predicting the occurrence of severe mycoplasma pneumoniae pneumonia.Methods Retrospective collection of 70 children with MPP hospitalized in Shaoxing People’s Hospital from January 2017 to May 2021,including 30 cases of severe mycoplasma pneumoniae pneumonia(SMPP)(severe pneumonia group)and 40 cases of ordinary mycoplasma pneumoniae pneumonia(MPP)(ordinary pneumonia group),and 45 children admitted due to dwarfism and precocious puberty were studied as normal control group.To compare the differences of serum complement C4,LDH,HBDH and other inflammatory markers among the three groups of children,and the diagnostic efficacy of serum complement C4,LDH,HBDH and ADA in predicting SMPP was evaluated by Subject’s ROC curve.Results The levels of complement C4,LDH,HBDH,LY,PA and ADA in the severe pneumonia group were(0.42±0.09)g/L,(375.66±87.64)U/L,(270.16±61.15)U/L,(1.38±0.46)×10~9/L,(88.01±27.33)mg/L and(23.54±4.70)U/L,The levels of complement C4,LDH,HBDH,LY,PA and ADA in the ordinary pneumonia group were(0.35±0.08)g/L,(268.87±37.42)U/L,(188.65±29.65)U/L,(1.95±0.60)×10~9/L,(114.36±29.86)mg/L and(19.34±3.41)U/L,The levels of complement C4,LDH,HBDH,LY,PA and ADA in the control group were(0.26±0.07)g/L,(232.50±27.93)U/L,(172.45±21.58)U/L,(2.60±0.48)×10~9/L,(214.25±30.03)mg/L and(13.75±2.55)U/L.The serum levels of complement C4,LDH,HBDH and ADA in severe pneumonia group were higher than those in the control group and ordinary pneumonia group(P<0.05),but the serum levels of LY and PA were lower than the two groups(P<0.05);The serum levels of complement C4,LDH and ADA in ordinary pneumonia group were higher than those in the control group(P<0.05),but the serum levels of LY and PA were lower than the control group,and there is no difference in the serum levels of HBDH between the two groups(P>0.05).The area under the ROC curve of serum complement C4,LDH,HBDH and ADA for predicting the occurrence of SMPP was 0.826(0.733,0.919),0.962(0.932,0.993),0.943(0.897,0.988),0.878(0.813,0.943).Conclusion The detection of serum complement C4,LDH,HBDH,ADA,LY and PA is helpful for the early diagnosis of SMPP.