特应质与儿童肺炎支原体肺炎严重程度及肺外表现相关性研究  

Impact of atopy on the severity and extra-pulmonary manifestations of childhood Mycoplasma pneumoniae pneumonia

作　　者：陈秀[1] 徐言芳 许立伦 CHEN Xiu;XU Yan-fang;XU Li-lun(Danyang Hospital Affiliated to Nantong University,Zhenjiang,Jiangsu 212000,China;Department of Pediatrics,Danyang Children's Hospital,Zhenjiang,Jiangsu 212000,China)

机构地区：[1]南通大学附属丹阳医院儿科,江苏镇江212000 [2]丹阳市儿童医院儿科,江苏镇江212000

出　　处：《临床肺科杂志》2020年第2期213-217,共5页Journal of Clinical Pulmonary Medicine

基　　金：江苏省卫生计生委2017年医学科研课题面上项目(No.H201752)

摘　　要：目的探讨特应质在肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia,MPP)儿童病情严重程度和肺外并发症中的作用,并阐明IL-17在其中的作用机制。方法回顾性纳入了2017年2月至2019年2月期间就诊于本院的221例MPP儿童,所有患者均行过敏原检测。采用相关性分析探索特应质和IL-17与病情及肺外并发症等相关性。结果221例MPP患儿中71例合并特应质,44例出现肺外并发症,其中以皮肤表现(36.4%)最为常见。有特应质MPP患者哮喘发作(P<0.001)和既往哮喘病史(P<0.001)比例、总IgE(P<0.001)显著高于无特应质患者,而IL-17(P<0.001)显著低于无特应质患者。有特应质MPP患者中更易出现重症肺炎(48/71 vs 17/150,P<0.001)。有特应质MPP患者出现胸腔积液(P=0.045)、呼吸急促(P<0.001)的比例、需氧疗(P<0.001)、糖皮质激素治疗的比例(P=0.008)以及糖皮质激素治疗时间(P=0.002)显著高于无特应质患者。合并肺外并发症MPP患者血浆IL-17(P=0.009)显著低于无肺外并发症患者,而总IgE水平(P=0.009)和特应质比例(P<0.001)显著高于无肺外并发症患者。结论特应质是导致MPP患儿病情严重和肺外并发症的危险因素之一,可能与IgE释放和IL-17降低相关。Objective To investigate the role of atopic sputum in the severity of extra-pulmonary complications in children with Mycoplasma pneumoniae pneumonia(MPP),and to elucidate the mechanism of action of IL-17.Methods A total of 221 MPP children who visited our hospital from February 2017 to February 2019 were retrospectively analyzed.All patients were tested for allergens.The correlation analysis was used to explore the relationship of atopy and IL-17 with the condition and extra-pulmonary complications.Results Among the 221 MPP cases,71 cases were diagnosed with atopy and 44 cases had extra-pulmonary complications.Skin manifestations(36.4%)were the most common extra-pulmonary complications.The proportion of asthma attack(P<0.001),history of asthma(P<0.001)and total IgE(P<0.001)in atopic patients were significantly higher,while IL-17(P<0.001)was significantly lower than those without atopy.Severe pneumonia was more common in patients with atopy(48/71 vs 17/150,P<0.001).The proportion of pleural effusion(P=0.045),tachypnea(P<0.001),aerobic therapy(P<0.001),steroid treatment(P=0.008)and duration of steroid therapy(P=0.002)were significantly higher than in patients with atopy.The level of plasma IL-17(P=0.009)in MPP patients with extra-pulmonary complications was significantly lower than those without extra-pulmonary complications,while the total IgE level(P=0.009)and the proportion of allergens(P<0.001)were significantly higher.Conclusion Atopy is one of the risk factors for severe MPP and extra-pulmonary complications,which may be related to the IgE release and decreased IL-17.

关 键 词：肺炎支原体 肺炎 肺外表现 特应质 儿童 

分 类 号：R725.6[医药卫生—儿科]