外周血T淋巴细胞亚群和细胞因子在儿童肺炎支原体肺炎诊断中的价值分析

Value of peripheral blood T-lymphocyte subsets and cytokines in the diagnosis of Mycoplasma pneumoniae pneumonia in children

目的 分析外周血T淋巴细胞亚群和细胞因子在儿童肺炎支原体肺炎(MPP)诊断中的价值。方法 选取2020年1月至2023年1月该院收治的120例MPP患儿为观察组,80例肺结核(TB)患儿为对照组,同期于该院查体中心查体的120例健康儿童为健康组。回顾性分析各组临床资料,采集受检者空腹静脉血,流式细胞仪检测各组受检者T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)水平,计算CD4^(+)/CD8^(+),采用酶联免疫吸附试验检测受检者干扰素(IFN)-γ、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、白细胞介素-13(IL-13)水平,比较各组受检者外周血T淋巴细胞亚群和细胞因子水平,采用受试者工作特征(ROC)曲线评估外周血T淋巴细胞亚群和细胞因子单独和联合检测在诊断儿童MPP中的价值。结果 观察组和对照组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IL-13、IL-10水平低于健康组(P<0.05),CD8^(+)、IL-8、IFN-γ水平高于健康组(P<0.05)。与对照组比较,观察组CD3^(+)、CD8^(+)、IL-10、IFN-γ水平偏高,CD4^(+)水平、CD4^(+)/CD8^(+)偏低(P<0.05),两组IL-8、IL-13水平比较差异均无统计学意义(P>0.05)。ROC曲线结果显示,CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、IL-8、IFN-γ、IL-13、IL-10单独诊断儿童MPP的曲线下面积(AUC)分别为0.751、0.687、0.784、0.864、0.798、0.672、0.650、0.811,联合检测的AUC为0.924。结论 TB和MPP患儿发病前期免疫功能明显减退,外周血T淋巴细胞亚群和细胞因子明显异常表达,与TB患儿比较,MPP患儿CD4^(+)水平、CD4^(+)/CD8^(+)偏低,CD3^(+)、CD8^(+)、IL-10、IFN-γ水平偏高,且T淋巴细胞亚群和细胞因子水平与患儿病情变化密切相关。CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、IL-8、IFN-γ、IL-13、IL-10联合检测为儿童MPP发病前期的甄别诊断提供了理论依据。

Objective To analyze the value of peripheral blood T-lymphocyte subsets and cytokines in the diagnosis of Mycoplasma pneumoniae pneumonia(MPP)in children.Methods A total of 120 children with MPP who were admitted to the hospital from January 2020 to January 2023 were selected as the observation group,80 children with pulmonary tuberculosis(TB)were selected as the control group.During the same period,120 healthy children who were examined at the hospital check-up center were selected as the health group.The clinical data from each group were retrospective analyzed,and fasting venous blood from subjects was collected.The levels of T-lymphocyte subsets CD3^(+),CD4^(+)and CD8^(+)were detected by flow cytometry in each group,and the CD4^(+)/CD8^(+)was calculated.The levels of interferon(IFN)-γ,interleukin-8(IL-8),interleukin-10(IL-10)and interleukin-13(IL-13)were measured by enzyme-linked immunosorbent assay,and the levels of peripheral blood T-lymphocyte subsets and cytokines in each group were compared.The receiver operating characteristic(ROC)curve was used to assess the value of peripheral blood T-lymphocyte subsets and cytokines in the diagnosis of MPP in children.Results The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IL-13,and IL-10 in the observation group and control group were significantly lower than those in the health group(P<0.05),while CD8^(+),IL-8,and IFN-γlevels were significantly higher than those in the health group(P<0.05).Compared with the control group,the observation group had higher levels of CD3^(+),CD8^(+),IL-8,IFN-γand lower levels of CD4^(+),CD4^(+)/CD8^(+)(P<0.05),and there were no statistically significant differences in IL-8 and IL-13 levels between the two groups(P>0.05).The ROC curve results showed that the area under the curve(AUC)or CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),IL-8,IFN-γ,IL-13,and IL-10 for the diagnosis of MPP in children were 0.751,0.687,0.784,0.864,0.798,0.672,0.650,and 0.811,and AUC of the combined detection was 0.924.Conclusion Children with TB and MPP have significantly decreased immune function in the early stages of the disease,and abnormal expression of peripheral blood T-lymphocyte subsets and cytokines.Compared with TB children,MPP children have lower levels of CD4^(+),CD4^(+)/CD8^(+),and higher levels of CD3^(+),CD8^(+),IL-10 and IFN-γ,and the T-lymphocyte subsets and cytokine levels are closely related to the changes in the patients′condition.The combined detection of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),IL-8,IFN-γ,IL-13 and IL-10 provides a theoretical basis for identifying and diagnosing early MPP in children.