血清蛋白成分及炎性细胞因子与支原体肺炎患儿病情严重程度的相关性研究

Correlation of serum protein composition and inflammatory cytokines with disease severity in children with mycoplasma pneumonia

目的检测支原体肺炎患儿血清白蛋白、α1、α2、β、γ球蛋白及κ、λ轻链、炎性细胞因子的水平,探讨其临床意义。方法选择2014年1月-2016年1月湖北省妇幼保健院儿科确诊的224例肺炎支原体肺炎(MPP)患儿,包括普通MPP患儿组163例,重症MPP组61例,同期健康体检儿童50例作为对照组。测定对照组和MPP组急性期及恢复期的血清蛋白成分比例变化及κ、λ轻链、IL-2、IL-6、IL-8、TNF-α水平。结果急性期,普通MPP组和重症MPP组的血白蛋白(albumin,ALB)比例均较对照组显著下降,α1、α2、γ球蛋白比例显著升高(P<0.05),以重症MPP组变化更加明显(P<0.05)。恢复期,普通MPP组和重症MPP组的ALB比例均较急性期升高,α1、α2、γ球蛋白比例均较急性期下降(P<0.05)。普通MPP组和重症MPP组的β球蛋白比例变化差异均无统计学意义(P>0.05)。急性期普通MPP组和重症MPP组的血IgG、IgA、IgM水平较对照组均显著升高(P<0.05),重症MPP组升高更加明显(P<0.05),恢复期IgG、IgA、IgM水平较急性期显著下降(P<0.05)。各组的κ轻链、λ轻链变化差异无统计学意义(P>0.05)。普通MPP组和重症MPP组在急性期血IL-2水平较对照组降低,hs-CRP、IL-6、IL-8、TNF-α较对照组升高,且以重症MPP组变化更加明显(P<0.05)。至恢复期,普通MPP组和重症MPP组的IL-2水平均较急性期升高,hs-CRP、IL-6、IL-8、TNF-α水平较急性期降低(P<0.05)。结论炎症因子参与了MPP的发生发展,血清蛋白电泳各成分比例的变化程度与MPP的病情轻重存在相关性,通过动态监测血清蛋白电泳各成分比例变化,可为MPP提供临床评估依据。

Objective To detect the levels of serum albumin,α1,α2,βandγglobulins,κandλlight chains and inflammatory cytokines in children with mycoplasma pneumonia,and to explore their clinical values.Methods Two hundred and twenty-four children diagnosed with Mycoplasma pneumoniae pneumonia(MPP)in Department of Paediatrics,Hubei Provincial Maternal and Child Health Care Hospital from January 2014 to January 2016 were selected to divide into the common MPP group(n=163)and the severe MPP group(n=61).And 50 children receiving health check-up during the same period served as the control group.The levels of serum protein composition in the acute and recovery stages and the levels ofκandλlight chains,IL-2,IL-6,IL-8 and TNF-αin the control group and the MPP group were measured.Results The albumin(ALB)ratio in the acute stage was significantly lower in the common and severe MPP groups than in the control group,but the ratios ofα1,α2 andγglobulins increased significantly(P<0.05),with more significant changes in the severe MPP group(P<0.05).The ALB ratios of the common and severe MPP groups in the recovery stage were higher than those in the acute stage,but the ratios ofα1,α2 andγglobulins in the recovery stage were all lower than those in the acute stage(P<0.05).No statistically significant difference was found in the change of ratio ofβglobulin between the common MPP group and the severe MPP group(P>0.05).The levels of IgG,IgA and IgM in the acute stage were significantly higher in the common and severe MPP groups than in the control group(P<0.05),and those in the severe MPP group increased more significantly(P<0.05).The levels of IgG,IgA and IgM in the recovery stage were significantly lower than those in the acute stage(P<0.05).No statistically significant differences were found in the changes ofκandλlight chains between the common MPP group and the severe MPP group in the acute and recovery stages(P>0.05).The level of IL-2 in the acute stage was lower in the common and severe MPP groups than in the control group(P<0.05),while the levels of hs-CRP,IL-6,IL-8 and TNF-αwere significantly higher in the common and severe MPP groups than in the control group(P<0.05),with more significant changes in the severe MPP group(P<0.05).In the common and severe MPP groups,the level of IL-2 was higher in the recovery stage than in the acute stage(P<0.05),while the levels of hs-CRP,IL-6,IL-8 and TNF-αin the recovery stage were all lower than those in the acute phase(P<0.05).Conclusions Inflammatory factors are involved in the occurrence and development of MPP.There is a correlation between the ratio of each composition of serum protein electrophoresis and the severity of MPP.Dynamical monitoring of the ratio of each composition of serum protein electrophoresis can provide a clinical evaluation basis for MPP.