儿童重症肺炎支原体肺炎实验室检查及免疫分析

Analysis of laboratory examination and immunology of severe Mycoplasma pneumoniae pneumonia in children

目的分析儿童重症肺炎支原体肺炎(SMPP)实验室检查和免疫学结果。方法行纤维支气管镜检查的肺炎支原体肺炎患儿97例,其中SMPP43例(SMPP组)和非SMPP54例(非SMPP组),收集患儿临床资料、血常规、生化指标和免疫学检测结果,检测支气管肺泡灌洗液(BALF)中微小RNA-222-3p(miR-222-3p)表达、肺炎支原体(MP)DNA及细胞因子,ROC曲线分析各指标对SMPP的诊断效能。结果SMPP组中性粒细胞计数、中性粒细胞/淋巴细胞比值、CRP、α-羟丁酸脱氢酶、乳酸脱氢酶、IgA和IgM均高于非SMPP组,淋巴细胞计数和CD3^(+)CD4^(+)低于非SMPP组(P<0.05)。SMPP组BALF中miR-222-3p表达、MPDNA以及IL-4、IL-6、IL-8、IL-1β、TNF-α水平均高于非SMPP组(P<0.05)。IL-8和TNF-α诊断SMPP的AUC分别为0.804和0.888,取最佳诊断界值分别为32.86ng/L和24.03ng/L时,其诊断SMPP的灵敏度分别为86.0%和83.7%,特异度为70.4%和92.6%。结论SMPP患儿炎症反应较重,免疫功能紊乱,与SMPP发生、发展密切相关。

Objective To analyze the laboratory examination and immunology of severe Mycoplasma pneumoniae pneumonia(SMPP)in children.Methods A total of 97 children with Mycoplasma pneumoniae pneumonia underwent fiberoptic bronchoscopy,of whom 43 children were diagnosed with SMPP(SMPP group)and 54 children were diagnosed with non-SMPP(non-SMPP group).The clinical data,blood routine,biochemical indexes and immunological results were collected.The expressions of miR-222-3p,Mycoplasma pneumoniae DNA and cytokines in bronchoalveolar lavage fluid(BALF)were detected.ROC curve was used to analyze the diagnostic efficiency of the indexes for SMPP.Results The neutrophil count,ratio of neutrophil to lymphocyte,CRP,α-hydroxybutyrate dehydrogenase,lactate dehydrogenase,IgA and IgM were higher,and lymphocyte count and CD3^(+)CD4^(+)were lower in SMPP group than those in non-SMPP group(P<0.05).The expressions of miR-222-3p,Mycoplasma pneumoniae DNA and the levels of IL-4,IL-6,IL-8,IL-1βand TNF-αin BALF in SMPP group were higher than those in non-SMPP group(P<0.05).The AUC value of IL-8 and TNF-αin the diagnosis of SMPP was 0.804 and 0.888.Taking 32.86 ng/L and 24.03 ng/L as the optimal cut-off value,the sensitivitiy was 86.0%and 83.7%,and specificitiy was 70.4%and 92.6%,respectively.Conclusion The children with SMPP have severe inflammatory response and immune dysfunction,which are closely related to the occurrence and development of SMPP.