肺泡灌洗液社区获得性呼吸窘迫综合征毒素表达与难治性肺炎支原体肺炎发生风险的相关性  

Correlation between expression of community-acquired respiratory distress syndrome toxin in bronchoalveolar lavage fluid and risk of refractory Mycoplasma pneumoniae pneumonia

作　　者：孙慧[1] 徐梅先[1] 李君娥[1] 郭艳梅[1] SUN Hui;XU Mei-xian;LI Jun-e;GUO Yan-mei(Intensive Care Unit,Hebei Children's Hospital,Shijiazhuang,Hebei 05003l,China)

机构地区：[1]河北省儿童医院重症监护科,河北石家庄050031

出　　处：《中华实用诊断与治疗杂志》2023年第4期406-409,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河北省医学科学研究重点课题计划(20170386)。

摘　　要：目的观察肺炎支原体肺炎患儿支气管肺泡灌洗液社区获得性呼吸窘迫综合征毒素(community-acquired respiratory distress syndrome toxin,CARDS Tx)表达变化,探讨其与难治性肺炎支原体肺炎(refractory Mycoplasma pneumoniae pneumonia,RMPP)发生的关系。方法186例肺炎支原体肺炎患儿均给予规范治疗,治疗后进展至RMPP者59例为RMPP组,余127例为对照组。比较2组胸腔积液、肺门淋巴结肿大等CT影像特征及入院次日血清C反应蛋白、降钙素原、乳酸脱氢酶等生化指标;采用实时荧光定量PCR法检测入院次日支气管肺泡灌洗液CARDS Tx相对表达量;采用多因素logistic回归分析肺炎支原体肺炎患儿进展至RMPP的影响因素;绘制限制性立方样条图,分析CARDS Tx表达与肺炎支原体肺炎患儿进展至RMPP的关系。结果RMPP组肺部病变影≥2/3肺(44.07%)、中大量胸腔积液比率(22.03%)均高于对照组(24.41%、9.45%)(χ^(2)=7.325,P=0.007;χ^(2)=5.484;P=0.019),体质量、病程及肺门淋巴结肿大、喘息比率与对照组比较差异均无统计学意义(P>0.05)。RMPP组血清C反应蛋白[(21.57±8.08)mg/L]、降钙素原[(1.67±0.29)μg/L]、乳酸脱氢酶[(286.17±38.66)u/L]及CARDS Tx相对表达量(6.22±1.10)均高于对照组[(16.43±4.49)mg/L、(1.58±0.26)μg/L、(261.54±42.37)u/L、4.86±1.24](P<0.05),血沉[(30.16±6.78)mm/h]快于对照组[(24.21±5.33)mm/h](t=-6.482,P<0.001),白细胞计数、血小板计数、中性粒细胞百分比、CD4^(+)/CD8^(+)及血清谷丙转氨酶、谷草转氨酶水平与对照组比较差异均无统计学意义(P>0.05)。肺部病变影≥2/3肺(OR=3.001,95%CI:1.146~7.858,P=0.025)、乳酸脱氢酶(OR=1.014,95%CI:1.001~1.027,P=0.031)、血沉(OR=1.211,95%CI:1.113~1.317,P<0.001)、CARDS Tx相对表达量(OR=3.648,95%CI:2.137~6.226,P<0.001)是肺炎支原体肺炎患儿进展至RMPP的影响因素。CARDS Tx表达与肺炎支原体肺炎患儿进展至RMPP风险呈线性关系(P=0.075)。结论支气管肺泡灌洗液Objective To observe the expression of community-acquired respiratory distress syndrome toxin(CARDS Tx)in bronchoalveolar lavage fluid in children with Mycoplasma pneumonia pneumoniae(MPP),and to explore its relationship with refractory MPP(RMPP).Methods A total of 186children with MPP received standard treatment,and were divided into RMPP group(n=59)and control group(n=127)according the progression after treatment.The CT imaging features such as pleural effusion and hilar lymph node enlargement,and the biochemical indexes such as serum C-reactive protein,procalcitonin and lactate dehydrogenase on the second day after admission were compared between two groups.The relative expression of CARDS Tx in bronchoalveolar lavage fluid on the second day after admission was detected by real-time fluorescence quantitative PCR.Multivariate logistic regression analysis was performed to analyze the influencing factors of RMPP.The restricted cubic spline regression model was used to analyze the relationship between CARDS Tx expression and RMPP.Results The percentages of patients with pulmonary lesion shadow≥2/3of lung field and massive pleural effusion were higher in RMPP group(44.07%,22.03%)than those in control group(24.41%,9.45%)(χ^(2)=7.325,P=0.007;χ^(2)=5.484,P=0.019),and there were no significant differences in the body mass index,disease course,and incidences of hilar lymph node enlargement and wheeze between two groups(P>00.5).The levels of C-reactive protein,procalcitonin and lactate dehydrogenase as well as the relative expression of CARDS Tx were higher in RMPP group[(21.57±8.08)mg/L,(1.67±0.29)μg/L,(286.17±38.66)u/L,6.22±1.10]than those in control group[(16.43±4.49)mg/L,(1.58±0.26)μg/L,(261.54±42.37)u/L,4.86±1.24](P<0.05),the erythrocyte sedimentation rate was faster in RMPP group[(30.16±6.78)mm/h]than that in control group[(24.21±5.33)mm/h](t=-6.482,P<0.001),and there were no significant differences in the white blood cell count,platelet count,percentage of neutrophils,CD4^(+)/CD8^(+),alanine aminot

关 键 词：肺炎支原体肺炎 难治性肺炎支原体肺炎 支气管肺泡灌洗液 社区获得性呼吸窘迫综合征毒素 

分 类 号：R725.6[医药卫生—儿科]