肺炎支原体肺炎患儿支气管肺泡灌洗液细胞因子特点与临床相关性分析

Cytokine characteristics and clinical correlation analysis of bronchoalveolar lavage fluid in children with mycoplasma pneumoniae pneumonia

目的 探讨支气管肺泡灌洗液(BALF)细胞因子在肺炎支原体肺炎(MPP)患儿中特点与临床因素间的相关性。方法 回顾性分析2019年12月—2021年11月本院收治的53例行支气管肺泡灌洗(BAL)的MPP患儿的临床资料,按临床特点进行分组,根据临床表现是否有发热分为发热组和无热组;根据病情分为重症组和非重症组;根据患儿胸部CT影像学特点分为实变组和非实变组。比较各组间细胞因子及与临床各因素间的差异。结果 (1)发热组BALF细胞因子IL-6和TNF-α的表达水平高于非发热组,差异具有统计学意义(P<0.05)。重症组BALF及血清细胞因子IL-6、IL-10、TNF-α和IFN-γ的表达水平均高于非重症组,差异具有统计学意义(P<0.05)。实变组BALF细胞因子IL-6、IL-10和IFN-γ水平高于非实变组,差异具有统计学意义(P<0.05)。(2)血乳酸脱氢酶(LDH)、D-二聚体、C反应蛋白(CRP)、血小板(PLT)、中性粒细胞/单核细胞比值(NLR)、白蛋白、IgA、IgM等指标在不同的组别也有变化。外周血WBC、LDH、D-二聚体、CRP与BALF细胞因子IL-6、IL-10、TNF-α、IFN-γ呈显著正相关(P<0.05)。(3)经受试者工作特征曲线(ROC)分析,BALF细胞因子中以IL-6、IL-10、TNF-α、IFN-γ最具有检验效能,AUC分别为0.933(95%CI:0.859~1.000,P<0.001),0.842(95%CI:0.730~0.953,P<0.001),0.814(95%CI:0.691~0.937,P<0.001)和0.845(95%CI:0.729~0.962,P<0.001)。结论 MPP患儿肺部炎症反应以IL-6、IL-10、TNF-α和IFN-γ为主。BALF细胞因子水平与MPP患儿是否发热、病情严重程度、肺部病变类型有关,能一定程度反应病情的严重程度。MPP患儿外周血LDH、CRP、D-二聚体、PLT、白蛋白等与BALF细胞因子存在相关性,与BALF细胞因子的结合可更好的评估肺部炎症及病情。

Objective To investigate the characteristics of bronchoalveolar lavage fluid(BALF)cytokines in children with Mycoplasma pneumoniae pneumonia(MPP)and its correlations with clinical factors.Methods The clinical data of 53 MPP children undergoing bronchoalveolar lavage(BAL)who were admitted to our hospital from December 2019 to November 2021were retrospectively analyzed.They were divided into fever group and no fever group according to clinical characteristics and the clinical manifestations of fever or not,divided into critical group and non-critical group according to their conditions,divided into consolidation group and non-consolidation group according to the CT imaging features of the chest.The differences in cytokines and clinical factors were compared among each group.Results The expression levels of BALF cytokines IL-6 and TNF-αwere significantly higher in the febrile group than those in the non-febrile group(P<0.05).The expression levels of BALF serum cytokines IL-6,IL-10,TNF-α,and IFN-γin the severe group were significantly higher than those in the non-severe group(P<0.05).The levels of BALF cytokines IL-6,IL-10,and IFN-γin the consolidation group were significantly higher than those in the non-consolidation group(P<0.05).Peripheral blood WBC,LDH,D-dimer,CRP were positively correlated with BALF cytokines IL-6,IL-10,TNF-αand IFN-γ(P<0.05).Receiver operating characteristic curve(ROC)analysis showed that the most effective power of test were IL-6,IL-10,TNF-αand IFN-γin BALF cytokines,with AUC of 0.933(95%CI:0.859~1.000,P<0.001),0.842(95%CI:0.730~0.953,P<0.001),0.814(95%CI:0.691~0.937,P<0.001)and 0.845(95%CI:0.729~0.962,P<0.001),respectively.Conclusions The inflammatory response in the lungs of children with MPP is dominated by IL-6,IL-10,TNF-αand IFN-γ.BALF cytokines levels are related to fever,the severity of the disease,and the type of lung lesion.Cytokine levels reflect the severity of the condition to some extent.The levels of peripheral blood LDH,CRP,D-dimer,PLT,albumin,etc.in children with MPP are correlated with BALF cytokines,and the combination with BALF cytokines testing can better assess lung inflammation and disease condition.