肺炎支原体肺炎合并哮喘患儿血清维生素D、CD5L、补体C3、IgE水平变化及与病情和炎症反应程度的关系

Changes of serum vitamin D,CD5L,complement C3 and IgE levels in children with MPP and asthma and their relationship with severity of illness and degree of inflammation

目的探讨肺炎支原体肺炎(MPP)合并哮喘患儿血清维生素D、CD5抗原样蛋白(CD5L)、补体C3、免疫球蛋白E(IgE)的水平变化及其临床意义。方法回顾性选取2020年1月—2022年6月长江大学附属荆州医院确诊的55例MPP合并支气管哮喘患儿作为观察组,另随机选取同期来该院就诊的55例MPP但无支气管哮喘患儿作为对照组。比较两组维生素D、CD5L、补体C3、补体C4、IgG、IgM、IgE、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、呼气流量峰值(PEF)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β_(1)(TGF-β_(1))、基质金属蛋白酶2(MMP-2)、MMP-9。结果观察组维生素D、CD5L低于对照组,补体C3、补体C4、IgG、IgM、IgE高于对照组(P<0.05)。观察组FVC、FEV1、PEF低于对照组,TNF-α、MMP-2、MMP-9高于对照组(P<0.05)。观察组与对照组TGF-β_(1)水平比较,差异无统计学意义(P>0.05)。高滴度组维生素D低于低滴度组,补体C3、IgG、IgM、IgE高于低滴度组(P<0.05)。高滴度组与低滴度组CD5L、补体C4水平比较,差异无统计学意义(P>0.05)。高滴度组FVC、FEV1、PEF低于低滴度组患者,TNF-α、MMP-2、MMP-9高于低滴度组(P<0.05)。高滴度组与低滴度组TGF-β_(1)比较,差异无统计学意义(P>0.05)。Pearson相关性分析显示,MPP合并哮喘患儿的血清维生素D与TNF-α、MMP-2和MMP-9呈负相关(r=-0.471、-0.663和-0.682,均P<0.05);CD5L与TNF-α、MMP-2、MMP-9呈负相关(r=-0.502、-0.610和-0.634,均P<0.05);TNF-α与补体C3、补体C4、IgG、IgM、IgE测定值水平无相关性(r=0.201、0.114、0.238、0.217、0.226,均P>0.05);TGF-β_(1)与维生素D、CD5L、补体C3、补体C4、IgG、IgM、IgE无相关性(r=-0.083、-0.112、0.233、0.172、0.132、0.094和0.104,均P>0.05);MMP-2与补体C3、补体C4、IgG、IgM、IgE无相关性(r=0.182、0.158、0.192、0.216和0.171,均P>0.05);患儿MMP-9与补体C3、补体C4、IgG、IgM、IgE无相关性(r=0.169、0.134、0.207、0.236和0.185,均P>0.05)。结论MPP合并哮喘患儿维生素D、CD5L水平降低,补体C3、IgE水平升高,并与患儿病毒抗体滴度水平、炎症反应程度有一定的关系。

Objective To explore the changes in serum levels of vitamin D,CD5 antigen-like protein(CD5L),complement C3,and immunoglobulin E(IgE)in children with Mycoplasma Pneumoniae Pneumonia(MPP)combined with asthma,and to investigate their clinical significance.Methods A retrospective study was conducted on 55 children diagnosed with MPP combined with bronchial asthma from January 2020 to June 2022 at Yangtze University Affiliated Jingzhou Hospital,designated as the observation group.Additionally,55 randomly selected MPP patients without bronchial asthma during the same period were selected as the control group.A comparison was made between the two groups in terms of vitamin D,CD5L,complement C3,complement C4,immunoglobulin G(IgG),immunoglobulin M(IgM),IgE,forced vital capacity(FVC),forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),tumor necrosis factor-α(TNF-α),transforming growth factor-β_(1)(TGF-β_(1)),matrix metalloproteinase-2(MMP-2),and MMP-9.Results In the observation group,vitamin D and CD5L were lower,while complement C3,complement C4,IgG,IgM,IgE were higher compared to the control group(P<0.05).FVC,FEV1,PEF were lower,and TNF-α,MMP-2,MMP-9 were higher in the observation group compared to the control group(P<0.05).There was no statistically significant difference in TGF-β_(1)levels between the observation and control groups(P>0.05).In the high-titer group,vitamin D was lower than in the low-titer group,and complement C3,IgG,IgM,IgE were higher than in the low-titer group(P<0.05).No significant difference was observed between the high and low-titer groups in terms of CD5L and complement C4 levels(P>0.05).Patients in the high-titer group had lower FVC,FEV1,PEF,and higher TNF-α,MMP-2,MMP-9 compared to the low-titer group(P<0.05).There was no significant difference in TGF-β_(1)levels between the high and low-titer groups(P>0.05).Pearson correlation analysis showed a negative correlation between serum vitamin D in MPP combined with asthma children and TNF-α,MMP-2,and MMP-9(r=-0.471,-0.663,and-0.682,respectively;all P<0.05);CD5L showed a negative correlation with TNF-α,MMP-2,and MMP-9(r=-0.502,-0.610,and-0.634,respectively;all P<0.05);TNF-αshowed no correlation with complement C3,complement C4,IgG,IgM,IgE levels(r=0.201,0.114,0.238,0.217,0.226,respectively;all P>0.05);TGF-β_(1)showed no correlation with vitamin D,CD5L,complement C3,complement C4,IgG,IgM,IgE levels(r=-0.083,-0.112,0.233,0.172,0.132,0.094,and 0.104,respectively;all P>0.05);MMP-2 showed no correlation with complement C3,complement C4,IgG,IgM,IgE levels(r=0.182,0.158,0.192,0.216,and 0.171,respectively;all P>0.05);MMP-9 showed no correlation with complement C3,complement C4,IgG,IgM,IgE levels(r=0.169,0.134,0.207,0.236,and 0.185,respectively;all P>0.05).Conclusion Children with MPP combined with asthma have lower levels of vitamin D and CD5L and higher levels of complement C3 and IgE.These levels are associated with viral antibody titers and the degree of inflammatory response in children.