外周血TLR4和NLRP3表达与小儿肺炎支原体肺炎病情的相关性分析

Correlation analysis of TLR4 and NLRP3 expression in peripheral blood with mycoplasma pneumoniae pneumonia in children

目的研究外周血Toll样受体-4(TLR4)、NOD样受体蛋白3(NLRP3)表达与小儿肺炎支原体肺炎(MPP)病情的相关性。方法回顾性选取2023年1月至2023年12月入山西省儿童医院的92例MPP患儿为观察对象,设为观察组;同时选取同期入院体检的40名健康儿童设为对照组。参考病情严重程度将观察组患儿划分为重症组(n=35)与轻症组(n=57)。采集各组儿童的血样,对单个核细胞内NLRP3、TLR4相对表达量予以测定,同时对血清白细胞介素(IL)-18、IL-1β水平予以测定。分析MPP患儿NLRP3、TLR4表达水平与IL-18、IL-1β水平的相关性,以及采用受试者操作特征(ROC)曲线评估MPP病情评估中NLRP3、TLR4价值。结果观察组患儿的NLRP3、TLR4、IL-18、IL-1β水平分别为1.94±0.12、0.76±0.10、(179.78±16.31)pg/mL、(6.82±1.19)pg/mL,均明显高于对照组[1.66±0.10、0.60±0.05、(86.83±13.88)pg/mL、(4.41±1.17)pg/mL],差异均有统计学意义(P<0.05)。重症组患儿的NLRP3、TLR4、IL-18、IL-1β水平分别为2.18±0.19、0.89±0.11、(213.09±19.58)pg/mL、(8.59±1.34)pg/mL,均明显高于轻症组[1.69±0.13、0.68±0.09、(150.57±14.97)pg/mL、(4.97±1.09)pg/mL],差异均有统计学意义(P<0.05)。Pearson分析结果显示,MPP患儿IL-18、IL-1β随NLRP3、TLR4升高而上升,呈正相关(P<0.05)。ROC曲线显示,重症MPP预测中NLRP3、TLR4曲线下面积分别为0.993、0.949,预测价值均较好(P<0.05)。结论MPP患儿的IL-18、IL-1β、NLRP3、TLR4水平均明显上升,且NLRP3、TLR4水平随IL-18、IL-1β水平升高而上升,NLRP3、TLR4可作为MPP患儿病情进展预测的辅助因子。

Objective To investigate the correlation between the expression of toll-like receptor-4(TLR4)and NOD-like receptor protein 3(NLRP3)in peripheral blood and the disease of mycoplasma pneumonia(MPP)in children.Methods A total of 92 MPP children admitted to Shanxi Children's Hospital from January 2023 to December 2023 were retrospectively selected as the observation group;40 healthy children admitted for physical examination in the same period were selected as the control group.According to the severity of the disease,the observation group was divided into the severe group(n=35)and the mild group(n=57).Blood samples were collected from each group of children to determine the relative expression of NLRP 3 and TLR 4 in mononuclear cells,and also for the serum interleukin(IL)-18 and IL-1βlevels.The correlation of NLRP 3 and TLR 4 expression levels with IL-18 and IL-1βlevels was analyzed.And the values of NLRP3 and TLR4 in MPP were analyzed by receiver operating characteristic(ROC)curve.Results The levels of NLRP3,TLR4,IL-18 and IL-1βin the observation group were 1.94±0.12,0.76±0.10,(179.78±16.31)pg/mL and(6.82±1.19)pg/mL,respectively,which were significantly higher than those in the control group[1.66±0.10,0.60±0.05,(86.83±13.88)pg/mL,(4.41±1.17)pg/mL],the differences were statistically significant(P<0.05).The levels of NLRP3,TLR4,IL-18 and IL-1βin the severe group were 2.18±0.19,0.89±0.11,(213.09±19.58)pg/mL and(8.59±1.34)pg/mL,respectively,which were significantly higher than those in the mild group[1.69±0.13,0.68±0.09,(150.57±14.97)pg/mL,(4.97±1.09)pg/mL],the differences were statistically significant(P<0.05).Pearson analysis showed that IL-18 and IL-1βincreased with NLRP 3 and TLR 4,showing a positive correlation(P<0.05).The ROC curve showed that the area under the NLRP 3 and TLR 4 curve in the severe MPP prediction was 0.993 and 0.949,respectively,the predictive value was good(P<0.05).Conclusion The levels of IL-18,IL-1β,NLRP 3 and TLR 4 increase significantly in children with MPP,and the levels of NLRP 3 and TLR 4 increase with the levels of IL-18 and IL-1β.NLRP 3 and TLR 4 could be used as cofactors for the prediction of disease progression in children with MPP.