难治性肺炎支原体肺炎患儿外周血TIM-3及其配体Galectin-9表达水平及意义

Expression levels and significance of peripheral blood TIM-3 and its ligand Galectin-9 in children with refractory Mycoplasma pneumoniae pneumonia

目的:探讨难治性肺炎支原体肺炎(RMPP)患儿血清T细胞免疫球蛋白黏蛋白分子3(TIM-3)及其配体半乳糖凝集素-9(Galectin-9)表达水平及其临床意义。方法:选取2020年1月至2021年12月我院儿科收治的120例RMPP患儿为RMPP组,选取同期109例普通肺炎支原体肺炎(GMPP)患儿为GMPP组,收集记录两组患儿年龄,性别,住院时间,肺外并发症,是否累及双侧肺,是否有胸腔积液、胸膜增厚、喘息、肺部湿啰音,C反应蛋白(CRP),白细胞(WBC)等资料。采用酶联免疫吸附测定(ELISA)法检测患儿血清TIM-3、Galectin-9水平;采用Pearson及Spearman相关分析RMPP患儿血清TIM-3、Galectin-9水平与住院时间、肺外并发症、累及双侧肺、CRP、WBC的相关性;绘制受试者工作特征(ROC)曲线,分析血清TIM-3、Galectin-9水平预测GMPP进展为RMPP的效能;采用多因素Logistic回归分析影响GMPP进展为RMPP的因素。结果:RMPP组血清TIM-3、Galectin-9、CRP、WBC水平,肺外并发症患儿比例,累及双侧肺患儿比例及住院时间显著高于或长于GMPP组(P<0.05)。RMPP患儿血清TIM-3与Galectin-9水平呈正相关(r=0.530,P<0.05);RMPP患儿血清TIM-3、Galectin-9水平与住院时间、CRP、WBC、肺外并发症、累及双侧肺呈正相关(P<0.05)。血清TIM-3、Galectin-9水平及二者联合预测GMPP进展为RMPP的曲线下面积(AUC)分别为0.811(95%CI 0.756~0.866)、0.793(95%CI 0.736~0.851)、0.862(95%CI 0.803~0.900),敏感度分别为66.7%、68.3%、78.3%,特异度分别为88.1%、78.9%、73.5%。TIM-3、Galectin-9是影响GMPP进展为RMPP的独立危险因素(P<0.05)。结论:RMPP患儿血清TIM-3、Galectin-9表达水平异常升高,二者联合检测可作为GMPP进展为RMPP的重要预测指标。

Objective:To investigate the expression levels of serum T cell immunoglobulin mucin molecule 3(TIM-3)and its ligand Galectin-9 in children with refractory Mycoplasma pneumoniae pneumonia(RMPP)and their clinical significance.Methods:A total of 120 children with RMPP admitted to the department of pediatrics of Chongqing Kaizhou Maternal and Child Health Hospital from January 2020 to December 2021 were selected as the RMPP group.Meantime,109 children with general Mycoplasma pneumoniae pneumonia(GMPP)were selected as the GMPP group.The general data of age,sex,hospital stay,extrapulmonary complications,bilateral lung involvement,pleural effusion,pleural thickening,wheezing,lung moist rale,C-reactive protein(CRP),white blood cell(WBC)were collected and recorded in the two groups.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of TIM-3 and Galectin-9.Pearson and Spearman correlation were used to analyze the correlation of serum TIM-3 and Galectin-9 levels with hospital stay,extrapulmonary complications,bilateral lung involvement,CRP,WBC in children with RMPP;receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of serum TIM-3 and Galectin-9 levels in predicting the RMPP evolving into GMPP;multivariate Logistic regression analysis was used to analyze the factors affecting the RMPP evolving into GMPP.Results:Serum TIM-3,Galectin-9,CRP and WBC levels,hospital stay,the proportion of children with extrapulmonary complications,and the proportion of children with bilateral lung involvement in the RMPP group were obviously higher than those in the GMPP group(P<0.05).There was a positive correlation between serum TIM-3 and Galectin-9 levels in children with RMPP(r=0.530,P<0.05);Serum TIM-3 and Galectin-9 in children with RMPP were positively correlated with hospital stay,CRP,WBC,extrapulmonary complications,and bilateral lung involvement(P<0.05).The areas under the curve(AUC)of serum TIM-3 and Galectin-9 levels and their combination predicting the progression of GMPP to RMPP were 0.811(95%CI 0.756-0.866),0.793(95%CI 0.736-0.851),0.862(95%CI 0.803-0.900),the sensitivity were 66.7%,68.3%and 78.3%,and the specificity were 88.1%,78.9%and 73.5%,respectively.TIM-3 and Galectin-9 were independent risk factors affecting the progression of GMPP to RMPP(P<0.05).Conclusion:The expression levels of serum TIM-3 and Galectin-9 in children with RMPP are abnormally increased,and the combined detection of the two can be used as an important predictor for the progression of GMPP to RMPP.