肺炎支原体肺炎患儿PBMC中TLR4、NF-κB、NLRP3炎性小体表达与病情及预后的关系研究

Relationship between TLR4,NF-κB and NLRP3 Inflammasomes in PBMC and Disease Severity,Prognosis of Children with Mycoplasma Pneumoniae Pneumonia

目的:分析肺炎支原体肺炎患儿外周血单个核细胞(PBMC)中Toll样受体4(TLR4)、核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体与病情及预后的关系。方法:选取2022年6月~2023年6月南京市江宁医院收治的100例肺炎原体感染肺炎患儿。根据病情严重程度分为轻症组(n=59例)和重症组(n=41例)。实时荧光定量(RT-PCR)检测患儿入组当日外周血PBMC中TLR4、NF-κB和NLRP3炎性小体m RNA水平。Spearman相关性分析TLR4、NF-κB和NLRP3炎性小体m RNA水平与病情严重程度关系。随访患儿6个月内的预后情况,采用受试者操作特征曲线评估TLR4、NF-κB、NLRP3炎性小体m RNA水平对患儿预后预测价值。结果:轻症组TLR4、NF-κB、NLRP3炎性小体m RNA水平均低于重症组(P<0.05)。TLR4、NF-κB、NLRP3炎性小体m RNA水平与疾病严重程度均呈正相关(r=0.652,r=0.553,r=0.617,P<0.05)。经随访预后良好患儿72例,预后不良患儿28例;预后不良患儿入组当日外周血PBMC中TLR4、NF-κB、NLRP3炎性小体m RNA水平高于预后良好患儿(P<0.05)。TLR4、NF-κB、NLRP3炎性小体m RNA水平评估肺炎支原体感染患儿预后的曲线下面积(AUC)分别为0.698、0.707、0.712,P均<0.05,联合检测的AUC为0.853。结论:肺炎支原体感染患儿TLR4、NF-κB、NLRP3炎性小体与病情严重程度呈正相关,且对预后有较高的预测价值。

Objective:To analyze the relationship between Toll-like receptor 4(TLR4)and nucleotide-binding oligomerization domain-like receptors family pyrin domain containing 3(NLRP3)inflammasomes in peripheral blood mononuclear cells(PBMC)and disease severity,prognosis of children with Mycoplasma pneumoniae pneumonia(MPP).Methods:A total of 100 children with MPP admitted to the Nanjing Jiangning Hospital were enrolled as observation objects between June 2022 and June 2023.According to disease severity,they were divided into mild group(n=59)and severe group(n=41).The mRNA levels of TLR4,nuclear factor-kappa B(NF-κB)and NLRP3 in PBMC were detected by real-time fluorescence quantitative polymerase chain reaction(RT-PCR)on enrollment day,and their relationship with disease severity was analyzed by Spearman analysis.The prognosis of children was followed up within 6 months.The prognostic value of TLR4,NF-κB and NLRP3 inflammasomes was evaluated by receiver operating characteristic(ROC)curves.Results:The mRNA levels of TLR4,NF-κB and NLRP3 inflammasomes in mild group were lower than those in severe group(P<0.05).The mRNA levels of TLR4,NF-κB and NLRP3 inflammasomes were positively correlated with disease severity(r=0.652,r=0.553,r=0.617,P<0.05).According to the follow-up,there were 72 cases with good prognosis and 28 cases with poor prognosis.The mRNA levels of TLR4,NF-κB and NLRP3 inflammasomes in PBMC in children with poor prognosis were higher than those with good prognosis(P<0.05).The area under the curve(AUC)values of TLR4,NF-κB and NLRP3 inflammasomes for evaluating prognosis of MPP children were 0.698,0.707 and 0.712,respectively(P<0.05).AUC of combined detection was 0.853.Conclusion:TLR4,NF-κB and NLRP3 inflammasomes are positively correlated with disease severity in MPP children,which all have high predictive value for prognosis.