儿童RMPP血清和支气管肺泡灌洗液中ATX水平的检测意义及其与免疫细胞、炎症因子的相关性

Detection significance of serum and bronchoalveolar lavage fluid ATX levels in children with RMPP and their correlation with immune cells and inflammatory factors

目的 探讨儿童难治性肺炎支原体肺炎(RMPP)血清和支气管肺泡灌洗液(BALF)中自分泌运动因子(ATX)的检测意义及其与免疫细胞、炎症因子的相关性。方法 将2019年6月至2022年10月吕梁市人民医院收治的80例RMPP患儿和80例普通肺炎支原体肺炎(GMPP)患儿纳入本次回顾性研究,分别作为RMPP组和GMPP组,RMPP组患儿在急性期接受支气管肺泡灌洗术(BAL)治疗,其中35例患儿在恢复期接受第2次BAL。比较2组血清和BALF中ATX、肺炎支原体(MP)载量、中性粒细胞比例、巨噬细胞比例及血清乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、降钙素原、D-二聚体表达,分析RMPP患儿急性期血清和BALF中autotaxin与MP载量、中性粒细胞比例、巨噬细胞比例、血清LDH、CRP、降钙素原、D-二聚体的相关性。结果 RMPP组急性期血清和BALF中ATX、MP载量、中性粒细胞比例分别为(23.14±6.17)mg/L、(19.90±5.52)pg/mL、(8.54±0.59)copies/mL、(31.25±10.64)%,显著高于恢复期[(7.76±1.91)mg/L、(6.25±1.64) pg/mL、(5.21±0.48) copies/mL、(7.09±3.15)%]和GMPP组[(4.36±1.30) mg/L、(3.31±1.26) pg/mL、(4.09±0.36) copies/mL、(5.22±2.57)%],而巨噬细胞比例为(26.33±8.02)%,显著低于恢复期[(39.17±8.99)%]和GMPP组[(60.11±21.42)%],差异均有统计学意义(P<0.05)。RMPP组急性期血清LDH、CRP、降钙素原、D-二聚体分别为(512.81±108.54)U/L、(31.56±10.58)mg/L、(0.25±0.07)ng/L和(6.16±1.09)mg/L,均显著高于恢复期[(295.52±72.36)U/L、(17.63±7.24)mg/L、(0.18±0.05)ng/L和(5.27±0.92)mg/L]和GMPP组[(246.98±50.47)U/L、(12.69±5.60)mg/L、(0.13±0.03)ng/L和(4.20±0.74)mg/L],差异均有统计学意义(P<0.05)。RMPP组患儿血清ATX与MP载量、中性粒细胞比例、LDH、CRP、降钙素原、D-二聚体呈正相关(r=0.701、0.689、0.599、0.721、0.628和0.679,P<0.001),与巨噬细胞比例呈负相关(r=-0.607,P<0.001);RMPP组患儿BALF中ATX与MP载量、中性粒细胞比例、LDH、CRP、降钙素原、D-二聚体呈正相关(r=0.763、0.730、0.571、0.677、0.654、0.641,P<0.001),与巨噬细胞比例呈负相关(r=-0.672,P<0.001)。结论 RMPP患儿血清和BALF中ATX显著升高,其与MP载量、中性粒细胞比例、CRP、LDH、降钙素原、D-二聚体呈正相关,与巨噬细胞比例呈负相关,提示ATX参与了RMPP的发生、发展,且可促进机体炎症反应,诱导免疫细胞趋化,参与了凝血功能失调。

Objective To investigate detection significance of serum and bronchoalveolar lavage fluid(BALF)autotaxin(ATX)in children with refractory mycoplasma pneumoniae pneumonia(RMPP)and its correlation with immune cells and inflammatory factors.Methods Eighty children with RMPP and 80 children with GMPP admitted to Lyuliang People's Hospital from June 2019 to October 2022 were enrolled in this retrospective study and were selected as RMPP group and GMPP group,all children in RMPP group received bronchoalveolar lavage(BAL)at acute stage.Among them,35 children were treated with second BAL at recovery stage.Serum and BALF ATX,MP load,neutrophil ratio,macrophage ratio and serum lactate dehydrogenase(LDH),C-reactive protein(CRP),procalcitonin and D-dimer were compared.The correlation between serum and BALF ATX and MP load,neutrophil ratio,macrophage ratio,serum LDH,CRP,procalcitonin and D-dimer of children with RMPP was analyzed.Results Serum and BALF ATX,MP load and neutrophil ratio in acute stage of RMPP group were(23.14±6.17)mg/L,(19.9±5.52)pg/mL,(8.54±0.59)copies/mL,(31.25±10.64)%respectively,which were much higher than those in recovery stage[(7.76±1.91)mg/L,(6.25±1.64)pg/mL,(5.21±0.48)copies/mL,(7.09±3.15)%]and GMPP group[(4.36±1.30)mg/L,(3.31±1.26)pg/mL,(4.09±0.36)copies/mL,(5.22±2.57)%],while macrophage ratio was(26.33±8.02)%,much lower than those in recovery stage[(39.17±8.99)%]and GMPP group[(60.11±21.42)%],the differences were statistically significant(P<0.05).Serum LDH,CRP,procalcitonin and D-dimer in acute stage in GMPP group were(512.81±108.54)U/L,(31.56±10.58)mg/L,(0.25±0.07)ng/L and(6.1±1.09)mg/L,respectively,which were much higher than those in recovery stage[(295.52±72.36)U/L,(17.63±7.24)mg/L,(0.18±0.05)ng/mL and(5.27±0.92)mg/L]and GMPP group[(246.98±50.47)U/L,(12.69±5.60)mg/L,(0.13±0.03)ng/L and(4.20±0.74)mg/L],the differences were statistically significant(P<0.05).In RMPP group,serum ATX was positively correlated with MP load,neutrophil ratio,LDH,CRP,procalcitonin and D-dimer(r=0.701,0.689,0.599,0.721,0.618 and 0.679,P<0.001),but negatively correlated with macrophage ratio(r=-0.607,P<0.001).In RMPP group,BALF ATX was positively correlated with MP load,neutrophil ratio,LDH,CRP,PCT and D-dimer(r=0.763,0.730,0.571,0.677,0.646 and 0.641,P<0.001),but negatively correlated with macrophage ratio(r=-0.672,P<0.001).Conclusion Serum and BALF ATX increased significantly in children with RMPP,and it positively correlated with MP load,neutrophil ratio,CRP,LDH,procalcitonin and D-dimer,and negatively correlated with the proportion of macrophages.It is suggested that ATX participates in the occurrence and development of RMPP,promotes the inflammatory reaction of the body,induces the chemotaxis of immune cells,and participates in the dysfunction of blood coagulation.