基于TLR4/MyD88/NF-κB通路探究肺炎支原体肺炎对患儿免疫功能的影响及其临床意义

Study on the influence of mycoplasma pneumoniae pneumonia on children′s immune function and its clinical significance based on TLR4/MyD88/NF-κB pathway

目的 基于TLR4/MyD88/NF-κB通路探究肺炎支原体肺炎(MPP)对患儿免疫功能的影响及其临床意义。方法 选择2021年10月至2022年10月住院的肺炎支原体肺炎(MPP)患儿100例为研究对象,根据病情严重程度分为重症组41例和非重症组59例;同期健康体检儿童50例设为对照组。均于入院当日抽取肘静脉血检测血清Toll样受体4(Toll-like receptor 4,TLR4)、下游髓样分化因子88(MyD88)、核因子-κB(NF-κB)的mRNA含量,炎症相关指标[γ干扰素(IFN-γ)、白细胞介素-8(IL-8)],体液免疫指标(IgE、IgG、IgM)、细胞免疫指标(CD4^(+)T、CD8^(+)T、CD4^(+)T/CD8^(+)T)。采用Pearson分析TLR4、MyD88、NF-κB的mRNA表达量与免疫功能指标的相关性。结果 重症组TLR4、MyD88、NF-κB mRNA、IFN-γ、IL-8、IgM、CD8^(+)T高于非重症组和对照组,IgA、CD4^(+)T、CD4^(+)T/CD8^(+)T低于非重症组和对照组;非重症组TLR4、MyD88、NF-κB mRNA、IFN-γ、IL-8、IgM、CD8^(+)T高于对照组,IgA、CD4^(+)T、CD4^(+)T/CD8^(+)T低于对照组,差异均有统计学意义(P<0.05)。IgA水平与TLR4、MyD88、NF-κB的mRNA含量均呈负相关(r=-0.706、-0.750、-0.642,P<0.05);IgM水平与TLR4、MyD88、NF-κB的mRNA含量均呈正相关(r=0.717、0.774、0.698,P<0.05);CD4^(+)T与TLR4、MyD88、NF-κB的mRNA含量均呈负相关(r=-0.758、-0.772、-0.637,P<0.05);CD8^(+)T与TLR4、MyD88、NF-κB的mRNA含量均呈正相关(r=0.757、0.734、0.629,P<0.05);CD4^(+)T/CD8^(+)T与TLR4、MyD88、NF-κB的mRNA含量均呈负相关(r=-0.746、-0.733、-0.636,P<0.05)。结论 MPP患儿血清TLR4、MyD88、NF-κB的mRNA含量增加与免疫功能相关指标的升高不一致性,提示TLR4/MyD88/NF-κB通路的激活可能导致免疫功能紊乱,并参与了重症MPP的发生过程。

Objective Based on TLR4/MyD88/NF-κB pathway,to study the effect of mycoplasma pneumoniae pneumonia(MPP)on children′s immune function and its clinical significance.Methods From October 2021 to October 2022,100 children with MPP were selected.According to the severity of the disease,they were divided into critical group(41 cases)and non-critical group(59 cases).At the same time,50 children with physical examination were set as control group.Elbow venous blood was collected on the day of admission to assess the serum mRNA contents of TLR4,MyD88,NF-κB,inflammatory indicators[interferon-γ(IFN-γ)and interleuking-8(IL-8)],humoral immune indicators(IgE,IgG,IgM),and cellular immune indicators(CD4^(+)T,CD8^(+)T,CD4^(+)T/CD8^(+)T)were observed.Pearson analysis was used to analyze the correlations between the mRNA expression of TLR4,MyD88,NF kB and immune function indicators.Results TLR4,MyD88,NF-κB mRNA,IFN-γ,IL-8,IgM and CD8^(+)T in the critical group were significantly higher than those in the non-critical group and the control group;and IgA,CD4^(+)T,and CD4^(+)T/CD8^(+)T were significantly lower than those in the non-critical group and the control group.TLR4,MyD88,NF-κB mRNA,IFN-γ,IL-8,IgM and CD8^(+)T in non-critical group were significantly higher than those in control group,while IgA,CD4^(+)T,CD4^(+)T/CD8^(+)T were significantly lower than those in control group(P<0.05).The mRNA contents of IgA were negatively correlated with TLR4,MyD88 and NF-κB mRNA(r=-0.706,-0.750,-0.642,P<0.05).The IgM level was positively correlated with TLR4,MyD88 and NF-κB mRNA(r=0.717,0.774,0.698,P<0.05).The mRNA contents of TLR4,MyD88 and NF-κB were negatively correlated with CD4^(+)T(r=-0.758,-0.772,-0.637,P<0.05).CD8^(+)T was positively correlated with TLR4,MyD88 and NF-κB mRNA(r=0.757,0.734,0.629,P<0.05).The mRNA contents of TLR4,MyD88 and NF-κB were negatively correlated with CD4^(+)T/CD8^(+)T(r=-0.746,-0.733,-0.636,P<0.05).Conclusion The increase of mRNA contents of TLR4,MyD88,and NF-κB in children with MPP is inconsistent with the increase of immune function related indicators,suggesting that the activation of TLR4/MyD88/NF-κB pathway may lead to immune dysfunction and participate in the development of severe MPP.