基于NLRP3炎性体信号通路在肺泡灌洗联合布地奈德局部喷洒对SMPP的疗效

Mechanism of pulmonary alveolar lavage combined with local budesonide spray therapy on SMPP based on NLRP3 inflammasome signaling pathway

目的探讨纤维支气管肺泡灌洗、布地奈德联合治疗重症肺炎支原体肺炎(SMPP)的临床疗效,分析可能作用机制。方法选取2019年1月至2022年1月收治的96例SMPP患儿为研究对象,采用奇偶数分组法分为研究组和对照组,每组48例。对照组予以纤维支气管肺泡灌洗治疗,研究组在对照组基础上予以布地奈德局部喷洒治疗。对比2组治疗7 d后临床疗效及临床症状改善时间。分析2组治疗前后肺功能指标(FEV1%pred、PEF、FEV1/FVC)、淋巴细胞亚群(CD19^(+))水平。对比2组治疗前后NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎性体信号通路相关因子[白细胞介素-1β(IL-1β)、白细胞介素-18(IL-18)]及其相关蛋白[NLRP3、凋亡相关的斑点样蛋白(ASC)、含半胱氨酸的天冬氨酸蛋白水解酶-1(Caspase-1)]表达水平。结果研究组总有效率高于对照组,临床症状改善时间短于对照组(P<0.05);治疗后,研究组FEV1%pred、FEV1/FVC、PEF高于对照组(P<0.05);治疗后,研究组CD19+绝对计数及比例低于对照组(P<0.05);治疗后,研究组IL-1β、IL-18水平及NLRP3、ASC、Caspase-1 mRNA表达水平低于对照组(P<0.05)。结论纤维支气管肺泡灌洗联合布地奈德局部喷洒治疗SMPP患儿疗效确切,可改善肺功能、免疫功能病理状态,减轻炎性反应,这可能与抑制NLRP3炎性体信号通路有关。

Objective To investigate the clinical efficacy of bronchoalveolar lavage combined with budesonide in the treatment of severe mycoplasma pneumonia(SMPP),and to analyze the possible mechanism.Methods A total of 96 children with SMPP admitted to our hospital from January 2019 to January 2022 were selected as research objects.They were divided into study group(n=48) and control group(n=48) by an odd-even number grouping method.The control group was treated with bronchoalveolar lavage,and the study group was treated with budesonide spray on the basis of the control group.The clinical efficacy and improvement time of clinical symptoms were compared between the two groups after 7 days of treatment.The levels of lung function indexes,including the predicted forced expiratory volume in the first second(FEV1%Pred),peak expiratory flow(PEF),and the ratio of FEV1 to forced vital capacity(FEV1/FVC) and lymphocyte subsets(CD19+) before and after the treatment were analyzed.Nod-like receptor heat protein domain associated protein 3(NLRP3) inflammasome signaling pathway related factors,such as interleukin-1β(IL-1β) and interleukin-18(IL-18),and related proteins including NLRP3,apoptosis-related spot-like protein(ASC),aspartic proteolytic enzyme containing cysteine(Caspase-1) before and after treatment were compared between the two groups.Results The total effective rate of the study group was higher than that of the control group,and the improvement time of clinical symptoms was shorter than that of the control group(P<0.05).After treatment,FEV1%Pred,FEV1/FVC and PEF in the study group were significantly higher than those in the control group(P<0.05).After treatment,the absolute count and proportion of CD19^(+) in the study group were lower than the control group(P<0.05).After treatment,the levels of IL-1β,IL-18 and the mRNA expressions of NLRP3,ASC and Caspase-1 in the study group were significantly lower than those in the control group(P<0.05).Conclusion The combination of bronchoalveolar lavage and local budesonide spray has a definite therapeutic effect on children with SMPP,which can improve lung function,immune function and pathological status,and reduce inflammatory response.The possible mechanism may be related to the inhibition of NLRP3 inflammasome signaling pathway.