社区获得性呼吸窘迫综合征毒素联合IFN-γ在儿童难治性支原体肺炎中检测价值的研究  

Study on the combination of community acquired respiratory distress syndrome toxin and IFN-γ to predict refractory Mycoplasma pneumoniae pneumonia in children

作　　者：郑宝英[1] 付涵宇 薛冠华 曹玲[1] Zheng Baoying;Fu Hanyu;Xue Guanhua;Cao Ling(Department of Pulmonology,the Children′s Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,China;Department of Bacteriology,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院呼吸内科,北京100020 [2]首都儿科研究所细菌研究室,北京100020

出　　处：《中华微生物学和免疫学杂志》2024年第12期1011-1017,共7页Chinese Journal of Microbiology and Immunology

基　　金：北京市属医院科研培育项目(PX2021050);国家自然科学基金项目(32170201,81401678)。

摘　　要：目的探讨社区获得性呼吸窘迫综合征(CARDS)毒素与IFN-γ检测在难治性肺炎支原体肺炎(RMPP)中的价值,为RMPP的早期识别提供帮助。方法选择临床诊断为肺炎支原体肺炎(MPP)的100例儿童为研究对象。其中RMPP患儿36例,非RMPP患儿64例设为对照组。对两组一般资料、临床症状、体征、实验室检查及肺内外并发症等进行统计学比较。应用二元Logistic回归分析筛选RMPP的独立危险因素,采用受试者工作特征(ROC)曲线分析指标的预测价值。结果RMPP组患儿发热时间、住院时间明显长于对照组,RMPP组CARDS毒素相对表达量、中性粒细胞比例、C-反应蛋白、D-二聚体、乳酸脱氢酶、IL-6及IFN-γ水平均高于对照组。二元Logistic回归分析显示发热时间长、IFN-γ及CARDS毒素相对表达量增高、出现肺外并发症是RMPP的独立危险因素。对发热时间、IFN-γ、CARDS毒素相对表达量3个连续变量进行ROC曲线绘制,3个指标联合检测时敏感度为86.1%,特异度为73.4%。结论CARDS毒素与MPP病情密切相关,发热时间、IFN-γ及CARDS毒素相对表达量、出现肺外并发症是RMPP的独立危险因素。尤其当发热时间大于10.5 d、IFN-γ大于31.79 pg/ml及CARDS毒素相对表达量大于1.18时应注意发展为RMPP的可能。Objective To investigate the value of community acquired respiratory distress syndrome(CARDS)toxin combined with IFN-γin the early prediction of refractory Mycoplasma pneumoniae pneumonia(RMPP).MethodsA total of 100 children diagnosed with Mycoplasma pneumoniae pneumonia(MPP)were selected as the study objects.Among them,36 cases were diagnosed with RMPP and 64 cases without RMPP were set as control group.The general data,clinical symptoms,signs,laboratory tests and internal and external pulmonary complications were compared between the two groups.The independent risk factors for RMPP was analyzed by Binary Logistic regression,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of the indicators.ResultsThe fever time and hospital stay in RMPP group were significantly longer than those in control group,the relative expression of CARDS toxin,neutrophil ratio,C-reactive protein,D-dimer,lactate dehydrogenase,IL-6 and IFN-γlevels in RMPP group were higher than those in control group,and the differences were statistically significant.Binary Logistic regression analysis showed that long fever duration,increased expression of IFN-γand CARDS toxin and extrapulmonary complications were independent risk factors for RMPP.ROC curves were drawn for the three continuous variables of fever time,IFN-γ,and relative expression of CARDS toxin,the sensitivity and specificity of the combined prediction of the three indexes were 86.1%and 73.4%,respectively.ConclusionsCARDS toxin is closely related to MPP.Fever duration,IFN-γ,relative expression of CARDS toxin and extrapulmonary complications are independent risk factors for RMPP.Especially when the fever time is more than 10.5 d,IFN-γis more than 31.79 pg/ml,and the relative expression of CARDS toxin is more than 1.18,the possibility of RMPP should be noted.

关 键 词：肺炎支原体肺炎 社区获得性呼吸窘迫综合征毒素 危险因素 儿童 

分 类 号：R725.6[医药卫生—儿科]