儿童重症肺炎支原体肺炎形成原因分析

Causes analysis of severe mycoplasma pneumoniae pneumonia in children

目的探讨儿童重症肺炎支原体肺炎(SMPP)的形成原因。方法纳入行支气管镜治疗的肺炎支原体肺炎(MPP)患儿74例,根据病情分为重症(SMPP)组43例和普通(GMPP)组31例,对比2组免疫球蛋白、淋巴细胞亚群、血及肺泡灌洗液细胞因子水平,荧光定量PCR检测BALF中肺炎支原体载量(MPL),计算MPL指数(MPLI),分析有统计学意义的指标与MPLI的相关性。结果与GMPP组相比,SMPP组患儿气道内更容易形成黏液栓(χ^(2)=10.689,P=0.001),而免疫球蛋白、T淋巴细胞亚群水平无差异(P>0.05),BALF中IL-6、TNF-α、IFN-γ、Th1/Th2、血清IL-6水平、MPLI显著增高(P<0.05),秩相关分析提示这些细胞因子水平均与MPLI有相关关系(P<0.05)。结论SMPP患儿感染局部炎性因子增高及Th1/Th2免疫失衡、气道内更易出现黏液栓,其形成可能与肺炎支原体高载量有关。

Objective To explore the causes of severe mycoplasma pneumoniae pneumonia(SMPP).Methods Totally 74 MPP children who were treated with fiberoptic bronchoscope were enrolled in the study,and the patients were allocated to the SMPP group(n=43)and general MPP(GMPP)group(n=31).The level of immunoglobulin,T-leukomonocyte subgroup,and cytokines in serum and bronchoalveolar lavage fluid(BALF)were included as comparisons.Mycoplasma pneumoniae load(MPL)in BALF was measured by fluorescent quantitative PCR(FQ-PCR),and MPL index(MPLI)was calculated.Correlations between MPL and significant indexes were evaluated.Results The SMPP group has more vulnerable to mucus embolisms in the airways(χ^(2)=10.689,P=0.001)compared with GMPP group.No difference in the level of blood immunoglobulin or T-leukomonocyte subgroup between groups(P>0.05).The levels of Interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),interferon-gamma(IFN-γ),T-helper 1(Th1)/Th2 and MPL in serum and BALF were significantly increased(P<0.05),and the rank correlation test showed that cytokines were correlated with MPL(P<0.05).Conclusion Local inflammatory cytokines are elevated,the immunity Th1/Th2 is imbalanced,mucoid impaction is more likely to develop,the formation of which may be associated with high mycoplasma pneumoniae loads.