小儿难治性肺炎支原体肺炎临床特征及免疫机制研究  

Clinical characteristics and immune mechanism of refractory Mycoplasma pneumoniae pneumonia in children

作　　者：刘月梅[1] 张磊[1] 赵二要 王静[1] 董利利[1] LIU Yuemei;ZHANG Lei;ZHAO Eryao;WANG Jing;DONG Lili(Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院、河南省儿童医院、郑州儿童医院呼吸科,郑州450000

出　　处：《中国中西医结合儿科学》2021年第1期21-24,共4页Chinese Pediatrics of Integrated Traditional and Western Medicine

基　　金：2018年度河南省医学科技攻关计划(联合共建项目)(2018020614)。

摘　　要：目的探讨难治性支原体肺炎(RMPP)小儿临床特征及免疫机制。方法以2017年3月至2019年3月本院收治的RMPP患儿92例为观察组,按病情轻重再分为RMPP重度组和RMPP轻度组。同期按1∶2收集46例普通肺炎患儿为对照组。应用流式细胞仪检测肺泡灌洗液中T细胞亚群水平,采用酶联免疫吸附试验检测白细胞介素-5(IL-5)、IL-6、肿瘤坏死因子ɑ(TNF-ɑ)水平及可溶性共刺激分子B7-H3(sB7-H3)表达水平,分析其中差异。结果RMPP重度组CD3、CD4水平及CD4/CD8值依次为(45.7±8.6)%、(20.4±6.5)%、0.97±0.14,均显著低于RMPP轻度组、对照组,差异有统计学意义(P<0.05);CD8水平为(20.6±3.3)%,与RMPP轻度组的(22.3±4.7)%比较差异无统计学意义(P>0.05)。RMPP重度组的IL-5、IL-6及TNF-ɑ水平分别为(18.7±3.2)ng/L、(27.2±1.3)ng/L、(112.7±13.5)ng/L,均显著高于RMPP轻度组、对照组,差异有统计学意义(P<0.05);sB7-H3表达水平为132.7 ng/L,显著高于对照组,差异有统计学意义(P<0.05),但与RMPP轻度组的sB7-H3比较差异无统计学意义(P>0.05)。结论IL-5、IL-6、TNF-ɑ及sB7-H3均参与患儿RMPP病情发展,表现为T细胞亚群CD3、CD4水平及CD4/CD8等指标紊乱,影响机体免疫功能,加重病情。Objective To study the clinical characteristics and immune mechanism of refractory Mycoplasma pneumonia pneumonia(RMPP)in children.Methods A total of 97 RMPP children treated in our hospital from March 2017 to March 2019 were included as the observation group,and they were divided into severe RMPP group and mild RMPP group.According to the ratio of 1∶2,46 children with common pneumonia in the same period were included as the control group.Flow cytometry was used to determine the level of T cell subsets in bronchoalveolar lavage fluid;enzyme-linked immunosorbent assay was used to determine the level of interleukin-5(IL-5),IL-6,tumor necrosis factorα(TNF-α)and sB7-H3;the differences in them were analyzed.Results The level of CD3 and CD4 and value of CD4/CD8 in severe RMPP group was(45.7±8.6)%,(20.4±6.5)%and 0.97±0.14,which were significantly lower than those of mild RMPP group and control group,and the differences were statistically significant(P<0.05).The CD8 level was(20.6±3.3)%in severe group,which was not statistically different from that in mild group[(22.3±4.7)%](P>0.05).The level of IL-5,IL-6 and TNF-αin severe RMPP group was(18.7±3.2)ng/L,(27.2±1.3)ng/L and(112.7±13.5)ng/L,respectively,which was significantly higher than that in mild RMPP group and control group(P<0.05).The level of sB7-H3 expression was 132.7 ng/L,significantly higher than that of control group(P<0.05),but it was not statistically different from that of mild group(P>0.05).Conclusion IL-5,IL-6,TNF-αand sB7-H3 are all involved in the disease progression of RMPP,which is manifested by the disorder of CD3,CD4 and CD4/CD8 of T cell Subsets,affecting the immune function of human body and aggravating the disease.

关 键 词：难治性支原体肺炎 淋巴细胞 细胞因子 支气管肺泡灌洗液 儿童 

分 类 号：R725.6[医药卫生—儿科]