重症肺炎支原体肺炎患儿血清E-选择素和P-选择素水平及临床意义  

Serum E-selectin and P-selectin levels in children with severe Mycoplasma pneumoniae pneumonia and their clinical significances

作　　者：卢琳 朱春梅[1] 姚海兰[2] Lu Lin;Zhu Chunmei;Yao Hailan(Department of Respiratory Medicine,Capital Institute of Pediatrics Children′s Hospital,Beijing 100020,China;Department of Biochemical Immunity,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院呼吸科,北京100020 [2]首都儿科研究所生化免疫室,北京100020

出　　处：《中华实用儿科临床杂志》2020年第22期1694-1697,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨血清E-选择素和P-选择素在重症肺炎支原体肺炎(MPP)发病机制中的作用,并评估其对重症MPP的早期临床识别价值。方法收集2017年12月至2018年10月首都儿科研究所附属儿童医院呼吸科病房收治的87例MPP患儿的临床资料。根据病情严重程度将入组患儿分为轻症组和重症组。轻症组37例,其中男20例,女17例;年龄(7.62±2.02)岁。重症组50例,其中男17例,女33例;年龄(6.97±2.41)岁。测定2组患儿血清E-选择素和P-选择素水平,对2组患儿血清E-选择素、P-选择素和相关炎症反应指标进行比较,并与重症MPP行相关性和受试者工作特征曲线(ROC)分析。结果与轻症组比较,重症组患儿住院时间[(8.46±2.53)d比(5.19±1.20)d,P<0.001]、C反应蛋白(CRP)水平[(23.05±37.05)mg/L比(15.06±13.79)mg/L,P=0.001]、乳酸脱氢酶(LDH)水平[(342.50±186.00)U/L比(284.44±64.82)U/L,P<0.001]、降钙素原(PCT)水平[(0.19±0.26)μg/L比(0.15±0.14)μg/L,P=0.012]、铁蛋白(SF)[(197.33±429.43)μg/L比(124.60±66.30)μg/L,P<0.001]、D-二聚体[(539.00±576.00)μg/L比(226.00±170.50)μg/L,P<0.001]、E-选择素[(2.36±4.22)μg/L比(0.86±0.20)μg/L,P<0.001]和P-选择素水平[(4.15±4.40)μg/L比(1.72±1.22)μg/L,P<0.001]均明显增高,差异均有统计学意义。2组白细胞(WBC)、红细胞沉降率(ESR)比较差异均无统计学意义。CRP、LDH、SF、D-二聚体、E-选择素、P-选择素与重症MPP相关(均P<0.05),而WBC、PCT、ESR与重症MPP无相关性。CRP、LDH、SF、D-二聚体、E-选择素、P-选择素的ROC曲线下面积均>0.5,其中,E-选择素的曲线下面积最大,P-选择素次之,均>0.8。结论重症MPP患儿可能存在机体过度炎症反应,E-选择素和P-选择素在该过程中可能起重要作用,且对重症MPP早期识别有较好提示价值。Objective To study the role of serum E-selectin and P-selectin in pathogenesis of severe Mycoplasma pneumonia pneumonia(MPP),and to evaluate their value in early clinical recognition of severe MPP.Methods The clinical data of 87 MPP patients in the Respiratory Ward of Capital Institute of Pediatrics Children′s Hospital between December 2017 and October 2018 were collected.Children were divided into the mild group(37 cases)and the severe group(50 cases)according to the severity of the disease.There were 20 males and 17 females in the mild group,with the age of(7.62±2.02)years.There were 17 males and 33 females in the severe group,with the of(6.97±2.41)years.Serum E-selectin,P-selectin and related inflammatory indicators were measured and compared between the two groups,and their correlation with severe MPP was analyzed.The receiver operating characteristic curve(ROC)analysis was also conducted.Results The length of stay[(8.46±2.53)d vs.(5.19±1.20)d,P<0.001],C-reactive protein(CRP)[(23.05±37.05)mg/L vs.(15.06±13.79)mg/L,P=0.001],lactate dehydrogenase(LDH)[(342.50±186.00)U/L vs.(284.44±64.82)U/L,P<0.001],procalcitonin(PCT)[(0.19±0.26)μg/L vs.(0.15±0.14)μg/L,P=0.012],serum ferritin(SF)[(197.33±429.43)μg/L vs.(124.60±66.30)μg/L,P<0.001],D-Dimer[(539.00±576.00)μg/L vs.(226.00±170.50)μg/L,P<0.001],E-selectin[(2.36±4.22)μg/L vs.(0.86±0.20)μg/L,P<0.001]and P-selectin[(4.15±4.40)μg/L vs.(1.72±1.22)μg/L,P<0.001]in the severe group were significantly higher than those in the mild group.There was no statistical difference in the white blood cell(WBC)and erythrocyte sedimentation rate(ESR).CRP,LDH,SF,D-Dimer,E-selectin and P-selectin were statistically correlated with severe MPP(all P<0.05),while WBC,PCT and ESR were not statistically correlated with severe MPP.The areas under ROC of CRP,LDH,SF,D-Dimer,E-selectin and P-selectin were all greater than 0.5,and the area under ROC of E-selectin was the largest,followed by that of P-selectin(both>0.8).Conclusions Severe MPP may lead to excessive inflamm

关 键 词：重症肺炎支原体肺炎 E-选择素 P-选择素 过度炎症反应 儿童 

分 类 号：R725.6[医药卫生—儿科]