肺炎支原体肺炎患儿支气管肺泡灌洗液白细胞介素-4、白细胞介素-6、干扰素-γ水平与病情和肺功能的关系

Relationships between interleukin-4,interleukin-6,interferon-γlevels of bronchoalveolar lavage fluid and disease condition and pulmonary function of children with Mycoplasma pneumonia pneumonia

目的:分析肺炎支原体肺炎(MPP)患儿支气管肺泡灌洗液(BALF)中白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)水平与病情和肺功能的关系。方法:选取徐州市儿童医院2019年5月至2020年10月收治的109例MPP患儿(研究组)和102例急性支气管异物患儿(对照组),均实施支气管肺泡灌洗术。研究组MPP患儿根据病情分为轻症组(85例)和重症组(24例),并根据患儿肺功能损伤程度分为肺功能正常组(26例)、轻度损伤组(32例)、中度损伤组(30例)和重度损伤组(21例)。取入组患儿BALF,采用酶联免疫吸附试验(ELISA)检测IL-4、IL-6、IFN-γ水平并进行比较;比较研究组不同病情、不同肺功能损伤患儿BALF中IL-4、IL-6和IFN-γ水平:两组间比较采用成组设计资料t检验;多组间整体比较采用方差分析后组间两两比较采用LSD-t检验。应用Pearson相关分析研究组患儿BALF中IL-4、IL-6、IFN-γ水平与肺功能的关系。结果:研究组患儿BALF中IL-4、IL-6、IFN-γ水平均高于对照组[IL-4:(142.4±24.7)pg/ml vs.(73.2±13.0)pg/ml,t=25.159、P<0.001;IL-6:(56.4±10.3)pg/ml vs.(11.2±2.3)pg/ml,t=43.399、P<0.001;IFN-γ:(90.2±16.3)pg/ml vs.(41.8±6.8)pg/ml,t=27.857、P<0.001]。研究组中重症组患儿BALF中IL-4、IL-6、IFN-γ水平分别为(200.7±36.7)pg/ml、(103.3±16.8)pg/ml和(113.5±21.9)pg/ml,均显著高于轻症组[(125.9±22.4)pg/ml、(43.1±7.8)pg/ml和(83.6±14.1)pg/ml](IL-4:t=12.378、P<0.001,IL-6:t=25.010、P<0.001,IFN-γ:t=8.035、P<0.001),差异有统计学意义。研究组中肺功能正常组患儿BALF中IL-4、IL-6和IFN-γ水平分别为(81.6±15.5)pg/ml、(20.4±4.2)pg/ml和(74.7±11.9)pg/ml,轻度损伤者分别为(102.5±19.9)pg/ml、(48.9±8.2)pg/ml和(89.2±11.1)pg/ml,中度损伤者分别为(145.7±25.2)pg/ml、(60.2±10.2)pg/ml和(95.4±12.8)pg/ml,重度损伤者分别为(273.7±42.1)pg/ml、(106.9±17.6)pg/ml和(103.2±13.2)pg/ml。肺功能轻度、中度、重度损伤组患儿BALF中IL-4、IL-6和IFN-γ水平均高于肺功能正常组(P均<0.05),肺功能中度、重度损伤组患儿以上指标水平均高于肺功能轻度损伤组(P均<0.05),肺功能重度损伤患儿均高于肺功能中度损伤者(IL-4:t=13.581、P<0.001,IL-6:t=11.956、P<0.001,IFN-γ:t=2.117、P=0.039),差异均有统计学意义。研究组患儿BALF中IL-4、IL-6、IFN-γ水平与1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、呼气流量峰值(PEF)均呈负相关(IL-4与FEV_(1)、FEV_(1)/FVC、PEF相关性:r=-0.834、P=0.025,r=-0.810、P=0.009,r=-0.901、P=0.002;IL-6与FEV_(1)、FEV_(1)/FVC、PEF:r=-0.816、P=0.003,r=-0.795、P=0.012,r=-0.743、P=0.007;IFN-γ与FEV_(1)、FEV_(1)/FVC、PEF:r=-0.756、P=0.012,r=-0.738、P=0.010,r=-0.725、P=0.017)。结论:MPP患儿BALF中IL-4、IL-6和IFN-γ水平均偏高,且3个指标水平与病情、肺功能均有关。

Objective To investigate the relationships between the levels of interleukin-4(IL-4),interleukin-6(IL-6)and interferon-γ(IFN-γ)of bronchoalveolar lavage fluid(BALF)and the disease condition and pulmonary function in children with Mycoplasma pneumoniae pneumonia(MPP).Methods Total of 109 cases with MPP(study group)and 102 cases of acute bronchial foreign bodies(control group)in Xuzhou Children’s Hospital Affiliated to Xuzhou Medical University from May 2019 to October 2020 were enrolled.The patients in study group were divided into mild disease group(85 cases)and severe disease group(24 cases)according to the conditions;and divided into normal lung function group(26 cases),mild lung function injury group(32 cases),moderate lung function injury group(30 cases)and severe lung function injury group(21 cases)according to the degree of lung function injury.The levels of IL-4,IL-6 and IFN-γof BALF among all cases were detected by enzyme-linked immunosorbent assay(ELISA).The levels of IL-4,IL-6 and IFN-γof BALF were compared among cases with different conditions and different grades of lung function injury.The above indexes were compared between two groups by t-test for group design data;multi-group overall comparison were taked by ANOVA,and pairwise comparison were analyzed by LSD-t test.The correlations between the levels of IL-4,IL-6,IFN-γof BALF and lung function were analyzed by Pearson correlation-analysis.Results The levels of IL-4,IL-6 and IFN-γof BALF of cases in study group were significantly higher than those of control group[IL-4:(142.4±24.7)pg/ml vs.(73.2±13.0)pg/ml:t=25.159,P<0.001;IL-6:(56.4±10.3)pg/ml vs.(11.2±2.3)pg/ml:t=43.399,P<0.001;IFN-γ:(90.2±16.3)pg/ml vs.(41.8±6.8)pg/ml:t=27.857,P<0.001].The levels of IL-4,IL-6 and IFN-γof BALF of children in severe injury group were(200.7±36.7)pg/ml,(103.3±16.8)pg/ml and(113.5±21.9)pg/ml,which were significantly higher than those of mild disease group[(125.9±22.4)pg/ml,(43.1±7.8)pg/ml and(83.6±14.1)pg/ml],with significant difference(t=12.378,P<0.001;t=25.010,P<0.001;t=8.035,P<0.001).The levels of IL-4,IL-6 and IFN-γof BALF in children with normal lung function were(81.6±15.5)pg/ml,(20.4±4.2)pg/ml,(74.7±11.9)pg/ml,and(102.5±19.9)pg/ml,(48.9±8.2)pg/ml,(89.2±11.1)pg/ml in mild lung function injury group,and(145.7±25.2)pg/ml,(60.2±10.2)pg/ml,(95.4±12.8)pg/ml in moderate lung function injury group,and(273.7±42.1)pg/ml,(106.9±17.6)pg/ml,(103.2±13.2)pg/ml in severe lung function injury group,respectively.The levels of IL-4,IL-6 and IFN-γin BALF of cases in mild,moderate and severe lung injury groups were significantly higher than those of normal lung function group(all P<0.05),the levels of the above three indexes of cases in moderate,severe lung injury function group were significantly higher than those of mild lung injury group(all P<0.05),and those of severe lung injury group were significantly higher than those of moderate lung injury group(IL-4:t=13.581,P<0.001;IL-6:t=11.956,P<0.001;IFN-γ:t=2.117,P=0.039),all with significant differences.The levels of IL-4,IL-6 and IFN-γof BALF in study group were negatively correlated with forced expiratory volume in 1 second(FEV_(1)),forced vital capacity(FVC),peak expiratory flow(PEF)(IL-4 with FEV_(1),FEV_(1)/FVC and PEF:r=-0.834,P=0.025;r=-0.810,P=0.009;r=-0.901,P=0.002;IL-6 with FEV_(1),FEV_(1)/FVC and PEF:r=-0.816,P=0.003;r=-0.795,P=0.012;r=-0.743,P=0.007;IFN-γwith FEV_(1),FEV_(1)/FVC and PEF:r=-0.756,P=0.012;r=-0.738,P=0.010;r=-0.725,P=0.017).Conclusions The levels of IL-4,IL-6 and IFN-γof BALF were increased in children with MPP,which were correlated with the disease conditions and lung function.