肺炎支原体肺炎患儿支气管肺泡灌洗液细胞因子特点及相关性分析  

Analysis of characteristics and correlation of cytokines in bronchoalveolar lavage fluid in children with Mycoplasma pneumoniae pneumonia

作　　者：谢晓虹[1] 王崇杰[1] 张光莉[1] 骆学勤[1] 罗征秀[1] 刘恩梅[1] 罗健[1] XIE Xiaohong;WANG Chongjie;ZHANG Guangli;LUO Xueqin;LUO Zhengxiu;LIU Enmei;LUO Jian(Department of Respiratory Medicine,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Children's Hospital of Chongqing Medical University,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院呼吸中心,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《临床儿科杂志》2020年第12期884-890,共7页Journal of Clinical Pediatrics

基　　金：重庆市科委社会事业与民生保障科技创新专项项目(No.cstc2017shmsA130036)。

摘　　要：目的分析肺炎支原体肺炎(MPP)支气管肺泡灌洗液(BALF)细胞因子特点、影响因素以及与外周血生化指标的相关性。方法回顾分析122例行支气管镜检的MPP患儿的临床资料,并对各组间各项指标及细胞因子进行比较。结果MPP患儿中男62例、女60例,中位年龄4岁(范围1~14岁),重症MPP 37例。BALF细胞因子增高前2位分别是IL-6和TNF-α,BALF细胞因子IL-6、TNF-α、IL-10和IFN-γ水平在有热组和无热组、持续发热组和热退组、阿奇霉素有效组和无效组之间差异有统计学意义(P<0.05)。重症MPP组IL-6、TNF-α、IFN-γ和IL-17A水平较普通MPP组明显增高,高拷贝数组TNF-α、IL-10和IFN-γ水平较低拷贝数组明显增高,实变组IL-6和TNF-α水平较斑片影组明显增高,上述差异均有统计学意义(P<0.05)。MPP患儿外周血D-二聚体与BALF细胞因子IL-6、IL-10、IFN-γ、TNF-α呈正相关(r=0.323~0.452,P均<0.001);外周血乳酸脱氢酶(LDH)与BALF细胞因子IL-6、TNF-α、IFN-γ呈正相关(r=0.229~0.347,P均<0.01);外周血白蛋白水平与BALF细胞因子IL-6、IL-10、TNF-α、IFN-γ呈负相关(r=-0.260^-0.214,P均<0.05)。结论MPP患儿局部炎症反应以IL-6和TNF-α为主。MPP患儿病情严重度、是否有发热症状、支气管镜检时是否持续发热、MP载量、肺内病变类型和阿奇霉素治疗效果均会影响BALF细胞因子检出水平。MPP患儿外周血D-二聚体、LDH和白蛋白与BALF细胞因子存在相关性,对评估肺部炎症情况有一定指导作用。Objective To analyze the characteristics of cytokines in bronchoalveolar lavage fluid(BALF)of Mycoplasma pneumoniae pneumonia(MPP)patients and its influence factors and correlations with biochemical index in peripheral blood.Method The clinical data of 122 children with MPP who underwent bronchoscopy were retrospectively analyzed,and the indicators and cytokines were compared between groups.Results In the MPP children(62 boys and 60 girls)aged 4 years old(1 to 14 years)on average,severe MPP was found in 37 patients.In BALF,two cytokines that were elevated most were IL-6 and TNF-α.The levels of IL-6,TNF-α,IL-10,and IFN-γin BALF were significantly different between fever group and non-fever group,between persistent fever group,and fever regression group,and between azithromycin effective and ineffective groups(P<0.05).The levels of IL-6,TNF-α,IFN-γ,and IL-17 A in severe MPP group were significantly higher than those in mild MPP group.The levels of TNF-α,IL-10,and IFN-γin high load group were significantly higher than those in low load group.The levels of IL-6 and TNF-αin lung consolidation group were significantly higher than those in lung patch shadow group(all P<0.05).There were positive correlations between levels of D-dimer and cytokines IL-6,IL-10,IFN-γ,and TNF-αin BALF of MPP children(r=0.323~0.452,P<0.001).Peripheral blood lactate dehydrogenase(LDH)level was positively correlated with IL-6,TNF-α,and IFN-γlevels in BALF(r=0.229~0.347,P<0.01).The serum albumin level was negatively correlated with levels of cytokines IL-6,IL-10,TNF-α,and IFN-γin BALF(r=-0.260^-0.214,P<0.05).Conclusion Local inflammatory response in MPP children is dominated by IL-6 and TNF-α.The severity of MPP,the presence of fever,persistent fever during bronchoscopy,MP load,and types of pulmonary lesions and the therapeutic effect of azithromycin all affect the levels of BALF cytokines.D-dimer,LDH and albumin in peripheral blood of MPP children are correlated with BALF cytokines and they play certain roles in guidance for the

关 键 词：肺炎支原体肺炎 支气管肺泡灌洗液 细胞因子 儿童 

分 类 号：R725.6[医药卫生—儿科]