肺泡灌洗液中细胞因子及细胞学水平与重症肺炎支原体肺炎的相关性  

Correlation of cytokine and cytology levels in bronchoalveolar alveolar lavage fluid of children with severe Mycoplasma pneumoniae pneumonia

作　　者：蔡辰 胡培培 陆敏[2] 顾浩翔[2] 丁国栋 Cai Chen;Hu Peipei;Lu Min;Gu Haoxiang;Ding Guodong(Department of Pediatrics,Shanghai East Hospital,Tongji University,Shanghai 200012,China;Department of Respiratory Medicine,Shanghai Children′s Hospital,Shanghai Jiaotong University,Shanghai 200040,China)

机构地区：[1]同济大学附属东方医院儿科,上海200012 [2]上海交通大学附属儿童医院呼吸科,200040

出　　处：《中华实用儿科临床杂志》2020年第18期1421-1424,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81972991)。

摘　　要：目的探讨重症肺炎支原体肺炎(SMPP)患儿支气管肺泡灌洗液(BALF)中细胞因子水平、常规细胞学水平及其临床意义。方法选取2018年7月至2019年2月上海交通大学附属儿童医院呼吸科行支气管肺泡灌洗术的肺炎支原体肺炎患儿207例,SMPP组121例,非SMPP组86例。采用流式微球捕获技术测定BALF中细胞因子水平,对BALF中细胞计数,比较2组间细胞因子、常规细胞学水平差异。应用受试者工作特征曲线(ROC)分析其对SMPP的预测价值。结果SMPP组BALF中细胞因子白细胞介素(IL)-8、IL-1β、IL-6水平和白细胞计数均显著高于非SMPP组[1717.77(784.31,3304.03)ng/L比1013.03(469.27,2040.52)ng/L、373.18(70.08,941.56)ng/L比107.50(0.10,489.88)ng/L、200.74(41.09,570.61)ng/L比95.47(0.10,337.68)ng/L、1890.00(955.00,3600.00)×10^6/L比1430.00(467.50,2724.00)×10^6/L],差异均有统计学意义(Z=3.27、3.45、2.47、2.57,均P<0.05),而SMPP组巨噬细胞百分比显著低于非SMPP组[0(0,0.06)比0.04(0,0.12)],差异有统计学意义(Z=-2.67,P=0.01)。IL-8的最佳临界值为722.69 ng/L,ROC曲线下面积(AUC)为0.63(95%CI:0.56~0.71,P<0.01);IL-1β的最佳临界值为166.33 ng/L,AUC为0.64(95%CI:0.56~0.72,P<0.01);IL-6的最佳临界值为142.95 ng/L,AUC为0.60(95%CI:0.52~0.68,P<0.05);白细胞总数最佳临界值为970×10^6/L,AUC为0.61(95%CI:0.53~0.69,P<0.05);巨噬细胞百分比最佳临界值为0.19,AUC为0.60(95%CI:0.32~0.48,P<0.05)。结论SMPP患儿BALF中细胞因子IL-8、IL-1β、IL-6水平和白细胞计数均高于非SMPP患儿,而巨噬细胞百分比低于非SMPP患儿。但细胞因子、细胞学水平对SMPP临床诊断的效能不高,不足以作为预测指标。Objective To investigate the clinical significance of cytokine levels and routine cytology in bronchoalveolar lavage fluid (BALF) in children with severe Mycoplasma pneumoniae pneumonia (SMPP).Methods A total of 207 children with Mycoplasma pneumoniae pneumonia who underwent parallel bronchoalveolar lavage in the Department of Respiratory, Shanghai Children′s Hospital, Shanghai Jiaotong University from July 2018 to February 2019 were enrolled in this study.There were 121 patients in the SMPP group and 86 patients in the non-SMPP group.Flow cytometry was used to determine the level of cytokines in BALF.Meanwhile, the cells in BALF were stained and cytokines levels and routine cytology were compared between the 2 groups.Receive operating characteristic(ROC) curves were used to analyze the predictive value of cytokine levels and routine cytology for SMPP.Results The levels of interleukin(IL)-8, IL-1βand IL-6 and white blood cell count in BALF of SMPP group were significantly higher than those of non-SMPP group [1 717.77 (784.31, 3 304.03) ng/L vs.1 013.03 (469.27, 2 040.52) ng/L, 373.18 (70.08, 941.56) ng/L vs.107.50 (0.10, 489.88) ng/L, 200.74 (41.09, 570.61) ng/L vs.95.47 (0.10, 337.68) ng/L, 1 890.00 (955.00, 3 600.00)×106/L vs.1 430.00 (467.50, 2 724.00)×106/L](Z=3.27, 3.45, 2.47, 2.57, all P<0.05). The percentage of macrophages in the non-SMPP group was significantly higher than that in the SMPP group [0.04 (0, 0.12) vs. 0 (0, 0.06)] (Z=-2.67, P=0.01). The optimal critical value and the area under curve (AUC) of IL-8 were 722.69 ng/L and 0.63 (95%CI: 0.56-0.71, P<0.01), respectively. The optimal critical value and AUC of IL-1β were 166.33 ng/L and 0.64, respectively (95%CI: 0.56-0.72, P<0.01). The optimal critical value and AUC of IL-6 were 142.95 ng/L and 0.60, respectively (95%CI: 0.52-0.68, P<0.05). The optimal critical value and AUC of the total white blood cells were 970×106/L and 0.61, respectively (95%CI: 0.53-0.69, P<0.05). The optimal critical value and AUC of the percentage of macrophages were

关 键 词：重症肺炎支原体肺炎 肺泡灌洗液 细胞因子 细胞学水平 

分 类 号：R725.6[医药卫生—儿科]