外周血Th17细胞/Treg细胞、IL-33水平与肺炎支原体肺炎患儿肺功能及预后的关系

Correlation of peripheral blood Th17/Treg cells and IL-33 levels with the lung function and prognosis in children with Mycoplasmal pneumoniae pneumonia

目的探究外周血辅助性T(Th)17细胞/调节性T(Treg)细胞、白细胞介素(IL)33水平与肺炎支原体肺炎(MPP)患儿肺功能及预后的关系。方法本研究为观察性研究,采用非随机抽样的方法选取2021年1月至2023年12月安康市中心医院收治的93例MPP患儿为研究对象。根据MPP病情严重程度分为重症MPP组(40例)和轻症MPP组(53例)。另外选择同期行健康体检的40名儿童为对照组。比较3组儿童肺功能指标[第1秒用力呼气容积(FEV 1)占预计值百分比(%pred)、用力肺活量(FVC)%pred、FEV 1/FVC%pred和呼气流量峰值(PEF)%pred]、外周血Th17细胞、Treg细胞与炎症细胞因子水平(IL-17、IL-10和IL-33)的差异。对MPP患儿中外周血Th17细胞/Treg细胞、IL-33与肺功能指标进行相关性分析。治疗结束后根据预后情况将MPP患儿分为预后良好组(66例)和预后不良组(27例),再次检测MPP患儿外周血Th17细胞、Treg细胞和IL-33水平,比较预后良好组与预后不良组Th17细胞/Treg细胞、IL-33水平的差异。绘制受试者操作特征(ROC)曲线分析治疗结束后再次检测的Th17细胞/Treg细胞、IL-33对MPP患儿预后不良的诊断价值,并采用平行试验进行联合诊断。结果重症MPP组男20例,女20例,年龄(5.23±1.69)岁;轻症MPP组男23例,女30例,年龄(5.29±1.58)岁;对照组男22名,女18名,年龄(5.32±1.71)岁;3组儿童性别和年龄比较差异均无统计学意义(均P>0.05)。重症MPP组和轻症MPP组FEV 1%pred、FVC%pred、FEV 1/FVC%pred、PEF%pred均低于对照组,且重症MPP组低于轻症MPP组,差异均有统计学意义(均P<0.05)。重症MPP组和轻症MPP组Th17细胞、Th17细胞/Treg细胞、IL-17、IL-33均高于对照组,而Treg细胞、IL-10均低于对照组,且重症MPP组Th17细胞、Th17细胞/Treg细胞、IL-17、IL-33均高于轻症组,而Treg细胞、IL-10均低于轻症MPP组,差异均有统计学意义(均P<0.05)。Spearman秩相关分析结果显示,MPP患儿中外周血Th17细胞/Treg细胞、IL-33与FEV 1%pred、FVC%pred、FEV 1/FVC%pred、PEF%pred均呈负相关(均P<0.05)。预后不良组Th17细胞/Treg细胞、IL-33均高于预后良好组[(0.21±0.06)比(0.14±0.03),(7.04±2.16)ng/L比(4.08±1.44)ng/L,均P<0.001]。ROC曲线分析显示,Th17细胞/Treg细胞、IL-33和二者联合诊断MPP患儿预后不良的曲线下面积分别为0.856(95%CI:0.751~0.962)、0.879(95%CI:0.790~0.968)、0.928(95%CI:0.859~0.996)。结论外周血Th17细胞/Treg细胞、IL-33水平与MPP患儿的肺功能指标呈负相关,且对患儿预后不良具有一定诊断价值。

ObjectiveTo explore the correlation of peripheral blood T helper(Th)17 cells/regulatory T(Treg)cells and interleukin(IL)-33 levels with the lung function and prognosis in children with Mycoplasmal pneumoniae pneumonia(MPP).MethodsThis was an observational study involving 93 children with MPP admitted to Ankang Central Hospital between January 2021 and December 2023 by non-random sampling method.According to MPP severity,patients were divided into severe MPP group(40 cases)and mild MPP group(53 cases).A total of 40 healthy children undergoing physical examination during the same period were enrolled as control group.Lung function indexes(forced expiratory volume in one second[FEV 1]as a percentage of the predicted value[%pred],forced vital capacity[FVC]%pred,FEV 1/FVC%pred,peak expiratory flow[PEF]%pred),peripheral blood Th17 cells,Treg cells and inflammatory cytokines(IL-17,IL-10,IL-33)in the three groups were compared.The correlation of Th17/Treg cells and IL-33 levels with the lung function indexes was analyzed.According to prognosis after treatment,MPP children were divided into good prognosis group(66 cases)and poor prognosis group(27 cases).Peripheral blood Th17 cells,Treg cells and IL-33 were detected again,and compared between the good prognosis group and poor prognosis group.The diagnostic value of Th17/Treg cells and IL-33 for the poor prognosis in MPP children was analyzed by plotting receiver operator characteristic(ROC)curves,and a combined diagnosis was performed by a parallel test.ResultsIn severe MPP group,there were 20 males and 20 females,with a mean age of(5.23±1.69)years.In mild MPP group,there were 23 males and 30 females,with a mean age of(5.29±1.58)years.In control group,there were 22 males and 18 females,with a mean age of(5.32±1.71)years.There were no significant differences in the gender and age among the three groups(all P>0.05).In severe MPP group,mild MPP group and control group,FEV 1%pred,FVC%pred,FEV 1/FVC%pred and PEF%pred gradually increased in sequence(all P<0.05).In severe MPP group,mild MPP group and control group,Th17 cells,Th17/Treg cells,IL-17 and IL-33 levels gradually decreased in sequence,while Treg cells and IL-10 levels gradually increased in sequence(all P<0.05).Spearman rank correlation analysis showed that peripheral blood Th17/Treg cells and IL-33 were negatively correlated with FEV 1%pred,FVC%pred,FEV 1/FVC%pred and PEF%pred in MPP children(all P<0.05).Th17/Treg cells([0.21±0.06]vs[0.14±0.03])and IL-33 levels([7.04±2.16]ng/L vs[4.08±1.44]ng/L)in poor prognosis group were significantly higher than those of good prognosis group(both P<0.001).ROC curves analysis showed that area under the curve of Th17/Treg cells,IL-33 and their combined detection in the diagnosis of poor prognosis of pediatric MPP was 0.856(95%CI:0.751-0.962),0.879(95%CI:0.790-0.968)and 0.928(95%CI:0.859-0.996),respectively.ConclusionPeripheral blood Th17/Treg cells and IL-33 are negatively correlated with lung function indexes in MPP children,which have certain diagnostic value for a poor prognosis.