难治性肺炎支原体肺炎患儿气道内分泌物半乳凝素-3与气道内中性粒细胞巨噬细胞及免疫炎症指标的相关性分析  

Correlation between bronchoalveolar lavage fluid galectin-3 and cellular immunityin airway neutrophils and macrophages in children with refractory pneumonia mycoplasmapneumonia

作　　者：刘祺 柳昌炳 卓超 陈亚艺 LIU Qi;LIU Chang-Bing;ZHUO Chao(Changxing County People's Hospital,Huzhou,Zhejiang 313100,China)

机构地区：[1]长兴县人民医院,浙江湖州313100

出　　处：《中国妇幼保健》2022年第14期2570-2573,共4页Maternal and Child Health Care of China

基　　金：浙江省湖州市科技局研究计划项目(2018GY48)。

摘　　要：目的探讨难治性肺炎支原体肺炎(RMPP)患儿支气管肺泡灌洗液(BALF)半乳凝素-3(Gal-3)与气道内中性粒细胞和巨噬细胞及免疫炎症指标的相关性,并分析其菌群特征。方法选取2016年6月—2018年6月期间在长兴县人民医院收治的难治性肺炎支原体肺炎患儿166例为观察组,均在入院7~10 d(急性期)给予支气管肺泡灌洗术干预治疗,其中102例患儿根据病情需要在治疗恢复期再次行支气管肺泡灌洗术。另选同期收治的50例支气管异物患儿为对照组。检测并比较两组患儿BALF中Gal-3、肺炎支原体(MP)载量、气道中性粒细胞比例、巨噬细胞比例、血清C-反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)及白细胞介素-6(IL-6)的差异,分析Gal-3与其他各项指标的相关性,并对两组BALF菌群多样性及差异性进行分析。结果与对照组相比,观察组患儿Gal-3、MP-DNA、气道中性粒细胞比例、CRP、TNF-α及IL-6水平均显著较高,巨噬细胞比例显著较低(P<0.05);与急性期相比,观察组患儿恢复期各指标差异均有统计学意义(均P<0.05);RMPP患儿急性期Gal-3水平与MP-DNA载量、中性粒细胞比例呈正相关(r=0.756,P<0.05;r=0.728,P<0.05);Gal-3水平与巨噬细胞比例呈负相关(r=-0.459,P<0.05);RMPP患儿Shannon指数、Simpson指数明显低于对照组,差异有统计学意义(P<0.05);RMPP患儿BALF中菌群占比在2%以上的依次是杆菌属、流感嗜血杆菌属、乳球菌属、假单孢菌属、链球菌属及葡萄球菌属等,对照组患儿BALF中菌群占比在2%以上的依次是乳球菌属、杆菌属、肉杆菌属、假单孢菌属、链球菌属及节细菌属等。结论Gal-3参与了RMPP患儿病理发展,与BALF中MP载量、中性粒细胞比例呈正相关,促进机体细胞和气道炎症反应;与巨噬细胞比例呈负相关,参与了单核细胞及巨噬细胞的趋化。RMPP患儿BALF菌群特征是呼吸道菌群紊乱,多样性下降。Objective To investigate the relationship between bronchoalveolar lavage fluid(BALF)galectin-3(Gal-3)and airway neutrophils,macrophages and immunoinflammatory markers in children with refractory pneumonia mycoplasma pneumonia(RMPP).And analyze its flora characteristics.Methods 166 children with refractory pneumonia mycoplasma pneumonia admitted to our hospital from June 2016 to June 2018 were selected as observation group.All patients were treated with bronchoalveolar lavage at 7-10 days after admission(acute phase).102 children underwent bronchoalveolar lavage again during the recovery period according to the condition.Another 50 children with bronchial foreign body admitted in the same period were the control group.Detecting and comparing Gal-3,Mycoplasma pneumoniae(MP)load,airway neutrophil ratio,macrophage ratio,serum C-reactive protein(CRP),tumor necrosis factor alpha(TNF-α)in BALF),the difference of interleukin-6(IL-6),the correlation between Gal-3 and other indicators,and the diversity and difference of BALF flora in the two groups were analyzed.Results Compared with the control group,the levels of Gal-3,MP-DNA,airway neutrophils,CRP,TNF-α,and IL-6 were significantly higher in the observation group,and the proportion of macrophages was significantly lower.Statistical significance(P<0.05);compared with the acute phase,there were significant differences in the above-mentioned indexes in the observation group(P<0.05);the Gal-3 level and MP in the acute phase of RMPP children-DNA load and neutrophil ratio were positively correlated(r=0.756,P<0.05;r=0.728,P<0.05);Gal-3 level was negatively correlated with macrophage ratio(r=-0.459,P<0.05);The Shannon index and Simpson index of children with RMPP were significantly lower than those of the control group(P<0.05).The proportion of bacteria in the BALF group was more than 2%,followed by Bacillus,Haemophilus influenzae,Lactococcus,Pseudomonas,Streptococcus,Staphylococcus,etc,in the control group,the percentage of bacteria in BALF is more than 2%,followed by Lactoco

关 键 词：难治性肺炎支原体肺炎 支气管肺泡灌洗术 半乳凝素-3 中性粒细胞 巨噬细胞 肺炎支原体载量 

分 类 号：R725.6[医药卫生—儿科]