儿童重症肺炎支原体肺炎血清CXCL10、CXCL16水平及临床意义

Serum CXCL10 and CXCL16 levels and clinical significance of severe Mycoplasma pneumoniae pneumonia in children

目的探讨儿童重症肺炎支原体肺炎血清CXC趋化因子配体10(CXCL10)、CXC趋化因子配体16(CXCL16)水平及临床意义。方法选取2019年1月至2021年1月在青岛市第八人民医院诊治的96例重症肺炎支原体肺炎患儿(重症肺炎支原体肺炎组)为研究对象,以同期在该院住院治疗的40例包茎、腹股沟斜疝手术患儿为对照组。重症肺炎支原体肺炎组根据简化小儿危重病例评分结果分为非危重组(80分<评分≤100分)34例、危重组(70分<评分≤80分)32例、极危重组(评分≤70分)30例。根据患儿治疗28 d后的预后情况将重症肺炎支原体肺炎组分为不良预后组(n=26)和预后良好组(n=70)。酶联免疫吸附试验法检测血清CXCL10、CXCL16及炎症指标[白细胞介素(IL)-6及肿瘤坏死因子(TNF)-α]水平。Pearson相关分析血清CXCL10、CXCL16水平与炎症指标的相关性。多因素Logistic回归分析影响重症肺炎支原体肺炎患儿不良预后的因素。受试者工作特征(ROC)曲线分析血清CXCL10、CXCL16及联合检测对重症肺炎支原体肺炎患儿不良预后的预测价值。结果重症肺炎支原体肺炎组血清CXCL10、CXCL16、C反应蛋白(CRP)、IL-6及TNF-α水平明显高于对照组,差异有统计学意义(P<0.05)。重症肺炎支原体肺炎患儿血清CXCL10与CRP、IL-6及TNF-α水平呈正相关(r=0.742、0.702、0.698,P<0.05),血清CXCL16与CRP、IL-6及TNF-α水平呈正相关(r=0.697、0.682、0.707,P<0.05)。非危重组、危重组及极危重组血清CXCL10、CXCL16水平比较,差异有统计学意义(P<0.05)。血清CXCL10、CXCL16水平升高为重症肺炎支原体肺炎患儿不良预后的独立危险因素。ROC曲线分析显示,血清CXCL10、CXCL16联合检测对重症肺炎支原体肺炎患儿不良预后预测的曲线下面积(AUC)为0.855,高于血清CXCL10、CXCL16单一指标检测对重症肺炎支原体肺炎患儿不良预后预测的AUC(0.774、0.779)。结论重症肺炎支原体肺炎患儿血清CXCL10、CXCL16联合检测对评估其不良预后具有较高的预测价值。

Objective To investigate the serum CXC chemokine ligand 10(CXCL10) and CXC chemokine ligand 16(CXCL16) levels and clinical significance of severe Mycoplasma pneumoniae pneumonia in children.Methods A total of 96 children with severe Mycoplasma pneumoniae pneumonia(severe Mycoplasma pneumoniae pneumonia group) diagnosed and treated in Qingdao Eighth People′s Hospital from January 2019 to January 2021 were selected as the study objects,and 40 children with phimosis and oblique inguinal hernia surgery in a hospital during the same period were selected as the control group.According to the simplified pediatric critical illness score results,the severe Mycoplasma pneumoniae pneumonia group was divided into 34 cases in the non-critical group(80 points score ≤100 points),32 cases in the critical group(70 points score ≤80 points),and 30 cases in the extremely critical group(score ≤70 points).According to the prognosis of the children after 28 days of treatment,the severe Mycoplasma pneumoniae pneumonia group was divided into poor prognosis group(n=26) and good prognosis group(n=70).The levels of serum CXCL10,CXCL16 and inflammatory indicators [interleukin(IL)-6 and tumor necrosis factor(TNF)-α] were detected by enzyme-linked immunosorbent assay.Pearson correlation analysis of serum CXCL10,CXCL16 levels and inflammatory indicators.Multivariate Logistic regression analysis of the factors affecting the poor prognosis of children with severe Mycoplasma pneumoniae pneumonia.The predictive value of serum CXCL10,CXCL16 and combined detection in children with severe Mycoplasma pneumoniae pneumonia was analyzed by receiver operating characteristic(ROC)curve.Results The levels of CXCL10,CXCL16,C-reactive protein(CRP),IL-6 and TNF-α in severe Mycoplasma pneumoniae pneumonia group were significantly higher than those in control group,with statistical significance(P<0.05).Serum CXCL10 was positively correlated with CRP,IL-6 and TNF-α levels in children with severe Mycoplasma pneumoniae pneumonia(r=0.742,0.702,0.698,P<0.05),and serum CXCL16 was positively correlated with CRP,IL-6 and TNF-α levels(r=0.697,0.682,0.707,P<0.05).There were significant differences in serum CXCL10 and CXCL16 levels among non-critical group,critical group and extremely critical group(P<0.05).Elevated levels of CXCL10 and CXCL16 were independent risk factors for poor prognosis in children with severe Mycoplasma pneumoniae pneumonia.ROC curve analysis showed that the combined detection of serum CXCL10 and CXCL16 had an area under the curve(AUC) of 0.855 for poor prognosis of children with severe Mycoplasma pneumoniae pneumonia.The AUC of serum CXCL10 and CXCL16 combined detection was higher than that of serum CXCL10 and CXCL16 single detection in predicting poor prognosis of children with severe Mycoplasma pneumoniae pneumonia(0.774 and 0.779).Conclusion The combined detection of CXCL10 and CXCL16 in serum of children with severe Mycoplasma pneumoniae pneumonia has a high predictive value in evaluating the adverse prognosis.