难治性支原体肺炎患儿肺泡灌洗液和血清中不同炎症相关分子的表达水平及诊断价值

Levels of inflammatory-related molecules in bronchoalveolar lavage fluid and serum in children with refractory Mycoplasma pneumoniae pneumonia and their diagnostic values

目的探讨血清及肺泡灌洗液(BALF)IL-4、IL-6、几丁质酶-3样蛋白-1(plaszyme-3-like protein-1, YKL-40)、半乳凝糖3(galactose 3, Gal-3)等炎症相关分子在难治性支原体肺炎(refractoryMycoplasma pneumoniae pneumonia, RMPP)患儿中的表达水平及联合诊断价值。方法选取徐州市儿童医院2022年11月1日至2023年8月30日住院的80例RMPP患儿作为RMPP组, 并选取同期行纤维支气管镜检查非支原体感染的大叶性肺炎患儿20例作为对照组, 比较两组患儿血清及BALF中IL-4、IL-6、YKL-40和Gal-3的表达水平, 并分析4项指标联合对RMPP的预测价值。结果 RMPP组血清IL-4、IL-6、YKL-40和Gal-3分别为(95.78±25.72)pg/mL、(36.41±11.66)pg/mL、(32.18±7.09)ng/mL和(44.85±14.41)pg/mL, 明显高于对照组(t=4.504、6.244、4.126和4.512, 均P<0.001)。RMPP组BALF中IL-4、IL-6、YKL-40和Gal-3分别为(108.35±28.62)pg/mL、(62.28±18.63)pg/mL、(6.18±0.75)ng/mL和(12.15±3.77)pg/mL, 明显高于对照组(t=3.690、5.050、6.821和4.935, 均P<0.001)。ROC曲线分析显示, 血清IL-4、IL-6、YKL-40和Gal-3联合预测RMPP的AUC为0.912, 灵敏度为66.3%, 特异性为100.0%。BALF中IL-4、IL-6、YKL-40和Gal-3联合预测RMPP的AUC为0.923, 灵敏度为87.5%, 特异性为95.0%。结论 RMPP患者血清及BALF中的IL-4、IL-6、YKL-40和Gal-3呈高表达, 血清或BALF中IL-4、IL-6、YKL-40和Gal-3联合应用对RMPP具有较高的诊断价值。

Objective To investigate the expression levels and combined diagnostic values of interleukin-4(IL-4),interleukin-6(IL-6),plaszyme-3-like protein-1(YKL-40)and galactose-3(Gal-3)in bronchoalveolar lavage fluid(BALF)and serum in children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods A total of 80 children with RMPP hospitalized in Xuzhou Children's Hospital from November 1,2022 to August 30,2023 were selected as the RMPP group,and 20 children with lobar pneumonia without mycoplasma infection who underwent fiberoptic bronchoscopy during the same period were selected as the control group.The expression levels of IL-4,IL-6,YKL-40,and Gal-3 in serum and BALF were compared between the two groups,and the combined predictive value of these four indicators for RMPP was analyzed.Results The levels of serum IL-4,IL-6,YKL-40 and Gal-3 in RMPP group were(95.78±25.72)pg/mL,(36.41±11.66)pg/mL,(32.18±7.09)ng/mL and(44.85±14.41)pg/mL,respectively,which were significantly higher than those in the control group(t=4.504,6.244,4.126 and 4.512,all P<0.001).The levels of IL-4,IL-6,YKL-40,and Gal-3 in BALF in RMPP group were(108.35±28.62)pg/mL,(62.28±18.63)pg/mL,(6.18±0.75)ng/mL and(12.15±3.77)pg/mL,respectively,which were significantly higher than those in the control group(t=3.690,5.050,6.821 and 4.935,all P<0.001).ROC curve analysis showed that the prediction of RMPP using combined serum IL-4,IL-6,YKL-40 and Gal-3 had an AUC of 0.912,a sensitivity of 66.3%and a specificity of 95.0%.The prediction of RMPP using combined BALF IL-4,IL-6,YKL-40 and Gal-3 had an AUC of 0.923,a sensitivity of 87.5%,and a specificity of 95.0%.Conclusions Levels of IL-4,IL-6,YKL-40 and Gal-3 in serum and BALF are highly expressed in RMPP patients,and the combination of IL-4,IL-6,YKL-40 and Gal-3 in serum or BALF has high diagnostic value for RMPP.