肺超声与T淋巴细胞及细胞因子在预测新生儿肺炎进展中的相关性研究

Study of the correlation between pulmonary ultrasound and T lymphocytes,cytokines in predicting the progression of neonatal pneumonia

目的:探讨肺超声肺实变与T淋巴细胞及细胞因子在预测新生儿肺炎进展中的相关性。方法:选取2021年2月至2023年2月间北京朝阳医院新生儿病房收治且首次肺超声检查发现存在肺实变的80例患儿为研究组,另选择同期50名健康体检的儿童为健康对照组,对比两组T淋巴细胞及细胞因子,另根据研究组治疗3d的病情情况再将其分为缓解组和进展组,采用多因素logistic回归分析新生儿肺炎病情进展的影响因素,采用Pearson相关性分析T淋巴细胞及细胞因子与病情进展的相关。结果:研究组患儿T淋巴细胞CD3+、CD8+、CD4+/CD8+细胞亚群和IL-17A、TNF-α、ICAM-1等细胞因子水平显著高于对照组(t=16.483、4.933、4.113、22.933、22.433、19.525,P<0.05),而CD4+水平显著低于对照组(t=7.773,P<0.05);进展组患儿CD3+细胞亚群和白细胞介素17A(IL-17A)、肿瘤坏死因子(TNF-α)、细胞间黏附分子-1(ICAM-1)等细胞因子水平显著高于缓解组(t=6.815、4.631、4.307,P<0.05),而CD4+水平显著低于缓解组(t=3.044,P<0.05);多因素logistic回归分析结果显示,CD3+表达降低、IL-17A表达升高、肺实变面积增加是新生儿肺炎进展的危险因素(β=-0.176、0.777、0.931,P<0.05);Pearson相关性分析结果显示,CD3+与新生儿肺炎进展呈负相关性(r=-0.295,P<0.001),而IL-17A以及肺实变面积与新生儿肺炎进展呈正相关性(r=0.677、0.517,P<0.001)。结论:CD3+和外周血IL-17A、肺实变面积表达及其变化情况,是肺炎进展的显著预测因素,且与肺炎进展密切相关。

Objective:To investigate the correlation between pulmonary ultrasound on pulmonary consolidation and T lymphocytes,cytokines in predicting the progression of neonatal pneumonia.Methods:A total of 80 pediatric patients with pulmonary consolidation,who admitted to neonatal ward of Beijing Chao-yang Hospital and were confirmed by the first ultrasound examination on lung from February 2021 to February 2023,were divided into study group,and 50 children,who underwent physical examination during the same period,were divided into control group.The cell subsets and cytokines between two groups were compared.The study group was further divided into mitigation group and progression group according to the disease conditions of pediatric patients of study group after they received 3 d treatment.Multifactor logistic regression was adopted to analyze the correlation among the T lymphocytes,cytokines and the progression of disease.Results:The CD3+,CD8+,CD4+/CD8+cell subsets of T lymphocytes and cytokines such as IL-17-A,TNF-αand ICAM-1 of study group were significantly higher than those of control group(t=16.483,4.933,4.113,22.933,22.433,19.525,P<0.05),respectively,and the CD4+level was significantly lower than that of control group(t=7.773,P<0.05).The CD3+cell subsets and cytokine levels such as IL-17A,TNF-αand ICAM-1 of progression group were significantly higher than those of mitigation group(t=6.815,4.631,4.307,P<0.05),however the CD4+level was significantly lower than that of mitigation group(t=3.044,P<0.05).The results of the multivariate Logistic regression analysis showed that the decrease of CD3+expression,the increase of IL-17A expression and the increase of the area of pulmonary consolidation were the risk factors of the progress of neonatal pneumonia(β=-0.176,0.777,0.931,P<0.05),respectively.The results of the Pearson-correlation analysis showed that CD3+was negative correlation with the progression of neonatal pneumonia(r=-0.295,P<0.001),however,the IL-17A and the area of pulmonary consolidation showed a positive correlation with the progression of neonatal pneumonia(r=0.677,0.517,P<0.001).Conclusion:The CD3+expression,IL-17A of peripheral blood and the area of pulmonary consolidation are significantly predictive factors of pneumonia progression,and are closely related to the progression of pneumonia.