中性粒细胞胞外诱捕网在儿童重症肺炎支原体肺炎中的意义  

Significance of neutrophil extracellular traps in severe Mycoplasma pneumoniae pneumonia in children

作　　者：董庆华 尹建运 苏杭 黄莉[2] 倪倩[3] DONG Qinghua;YIN Jianyun;SU Hang;HUANG Li;NI Qian(The Second Clinical Medical College,Lanzhou University,Lanzhou 730001,China;Department of Pediatric Nephrology,the Second Hospital of Lanzhou University,Lanzhou 730001,China;Department of Pediatric Respiratory,the Second Hospital of Lanzhou University,Lanzhou 730001,China)

机构地区：[1]兰州大学第二临床医学院,甘肃兰州730001 [2]兰州大学第二医院小儿肾病科,甘肃兰州730001 [3]兰州大学第二医院小儿呼吸科,甘肃兰州730001

出　　处：《新医学》2024年第7期520-526,共7页Journal of New Medicine

基　　金：甘肃省自然科学基金(22JR5RA1006);兰州市科技发展指导性计划项目(2020-ZD-98);兰州大学第二医院“萃英科技创新”计划项目(CY-2020-MS13)。

摘　　要：目的探讨中性粒细胞胞外诱捕网(NETs)在儿童重症肺炎支原体肺炎(SMPP)发生、发展中的作用,并评价其对SMPP的预测价值。方法选择2023年10月至12月兰州大学第二医院收住院的肺炎支原体肺炎(MPP)患儿为研究对象,分为非重症组(MPP组,n=45例)和重症组(SMPP组,n=39)。采用ELISA检测2组患儿血清中NETs质量浓度。分别收集SMPP组患儿的患侧肺及健侧肺肺泡灌洗液(BALF),采用ELISA检测BALF中NETs质量浓度。结果MPP与SMPP患儿血清中NETs质量浓度比较差异有统计学意义(P<0.01)。SMPP组患侧肺BALF中的NETs质量浓度高于健侧肺(P<0.001)。SMPP组血清中NETs质量浓度高于BALF(P<0.001)。血清中NETs质量浓度预测SMPP的受试者操作特征曲线下面积(ROC AUC)为0.892(95%CI 0.810~0.963,P<0.001),灵敏度为0.821,特异度为0.875,截断值为17.24 ng/mL;血清中NETs联合C-反应蛋白(CRP)、乳酸脱氢酶(LDH)预测SMPP的ROC AUC为0.974(95%CI 0.946~1.000,P<0.001),灵敏度为0.923,特异度为0.950。结论MPP患儿中过度激活的NETs可能与SMPP的发生及SMPP的局部肺损伤有关。检测MPP患儿血清中NETs、CRP、LDH水平可有效预测SMPP,其中以联合预测的效能最优。Objective To investigate the pathogenic role of neutrophil extracellular traps(NETs)in the pathogenesis and progression of severe Mycoplasma pneumoniae pneumonia(SMPP)in children and to assess their predictive value for SMPP.Methods Children with Mycoplasma pneumoniae pneumonia(MPP)admitted to the Second Hospital of Lanzhou University from October to December 2023 were selected as the study subjects.They were divided into the non-severe group(MPP group,n=45)and severe group(SMPP group,n=39).The levels of NETs in the serum and bronchoalveolar lavage fluid(BALF)of all children were measured using ELISA.Additionally,BALF from both the affected and contralateral sides was collected from children in the SMPP group,and the content of NETs in BALF was determined using ELISA.Results A significant difference was observed in the serum concentration of NETs between MPP and SMPP patients(P<0.01).In the SMPP group,the level of NETs in the BALF of the affected lung was significantly higher than those of the contralateral side(P<0.001).Serum NETs levels were significantly higher than those in BALF in SMPP group(P<0.001).The area under the ROC curve(AUC)for predicting SMPP based on serum NETs levels was 0.892(95%CI 0.810-0.963,P<0.001),with a sensitivity of 0.821 and specificity of 0.875,and a cut-off value of 17.24 ng/mL,respectively.The AUC of the combination of serum NETs with C-reactive protein(CRP)and lactate dehydrogenase(LDH)levels for predicting SMPP was 0.974(95%CI 0.946-1.000,P<0.001),with a sensitivity of 0.923 and specificity of 0.950,respectively.Conclusions Excessive activation of NETs may contribute to the incidence of SMPP and localized lung injury in children with MPP.Monitoring the serum levels of NETs,CRP and LDH can effectively predict the incidence of SMPP.The combination of NETs,CRP,and LDH yields the best predictive performance.

关 键 词：儿童 中性粒细胞胞外诱捕网 重症肺炎支原体肺炎 肺泡灌洗液 C-反应蛋白 乳酸脱氢酶 

分 类 号：R725.6[医药卫生—儿科]