肺炎支原体肺炎患者Th17/Treg免疫平衡与MP-IgM抗体滴度的关系及对预后的预测价值  

Relationship between Th17/Treg immune balance and MP-IgM titer in patients with Mycoplasma pneumoniae pneumonia and its predictive value for prognosis

作　　者：刘亚峰[1] 闫春良[1] 任冠军[1] 郑清月 雷芸[1] 杨丽霞[2] Liu Yafeng;Yan Chunliang;Ren Guanjun;Zheng Qingyue;Lei Yun;Yang Lixia(Department of Respiratory and Critical Care Medicine,Beijing Aerospace General Hospital,Beijing 100076,China;Department of Infectious Disease,The First Affiliated Hospital of Nanchang University,Nanchang Jiangxi 330006,China)

机构地区：[1]北京航天总医院呼吸与危重症医学科,北京100076 [2]南昌大学第一附属医院感染科,江西南昌330006

出　　处：《中国医刊》2025年第2期149-155,共7页Chinese Journal of Medicine

基　　金：江西省自然科学基金(20192BAB205090);江西省中医药管理局科技计划(2020A0174)。

摘　　要：目的分析肺炎支原体肺炎(MPP)患者辅助性T细胞17(Th17)/调节性T细胞(Treg)免疫平衡与肺炎支原体(MP)-IgM抗体滴度的关系及对预后的预测价值。方法选择2020年2月至2023年12月于北京航天总医院治疗的206例MPP患者为研究对象,根据MP-IgM抗体滴度分为低滴度组(n=57)、中滴度组(n=90)和高滴度组(n=59),根据预后情况分为预后良好组(n=118)和预后不良组(n=88)。采用广义相加模型(GAM)分析MP-IgM抗体滴度与相关因素的关系,采用多因素logistic回归分析筛选预后不良的危险因素,采用限制性立方样条(RCS)分析剂量反应关系,采用非条件logistic回归模型及计算表分析交互作用,采用受试者操作特征(ROC)曲线评估MP-IgM抗体滴度、Th17/Treg比值对MPP患者预后的预测效能。结果与低滴度组相比,中滴度组和高滴度组患者的Th17细胞百分比、Th17/Treg比值更高,Treg细胞百分比更低(P<0.05);与中滴度组相比,高滴度组患者的Th17细胞百分比、Th17/Treg比值更高(P<0.05),Treg细胞百分比更低(P<0.05)。GAM分析结果显示,Th17细胞百分比越高、Treg细胞百分比越低、Th17/Treg比值越高,则MP-IgM抗体滴度越高(P<0.05)。MP-Ig M抗体滴度、胸腔积液、中性粒细胞/淋巴细胞比值(NLR)、D-二聚体(D-D)、Th17/Treg比值、抗生素治疗使用时间,均为MPP患者预后不良的独立影响因素(P<0.05)。RCS分析结果显示,Th17/Treg比值与预后不良风险存在非线性关系(非线性检验P<0.001)。交互作用分析结果显示,Th17/Treg比值(≥0.95)与MP-IgM抗体滴度(高滴度)对MPP患者预后不良存在相加交互作用(P<0.05)。ROC曲线分析显示,Th17/Treg比值与MP-IgM抗体滴度联合应用对MPP患者预后不良的预测价值较高,曲线下面积为0.819(95%CI 0.734~0.881)。结论MP-IgM抗体滴度、Th17/Treg比值均是MPP患者预后不良的独立影响因素,且二者对预后不良有相加交互作用;Th17/Treg比值与预后不良风险呈非线性关�Objective To explore the relationship between helper T cell 17(Th17)/regulator T cell(Treg)immune balance and MP-IgM antibody titers in patients with Mycoplasma pneumoniae pneumonia(MPP),and its predictive value for prognosis.Method MPP patients(n=206)treated in Beijing Aerospace General Hospital from February 2020 to December 2023 were selected as the research subjects.According to the titer of MP-IgM antibodies,they were divided into low titer group(n=57),medium titer group(n=90),and high titer group(n=59).According to the prognosis,they were divided into good prognosis group(n=118)and poor prognosis group(n=88).Generalized additive model(GAM)was used to analyze the relationship between MPIgM antibody titers and related factors.Multiple Logistic regression was used to analyze risk factors.Restricted cubic splines(RCS)was used to analyze dose-response relationships.Unconditional Logistic regression model and calculation table were used to analyze the interaction effects.Receiver operating characteristic(ROC)curve was used to evaluate predictive performance.Result Compared with the low titer group,patients in the medium titer group and high titer group had higher Th17 cell ratios and Th17/Treg ratios(P<0.05),while Treg cell ratios were lower(P<0.05);Compared with the medium titer group,the Th17 cell ratio and Th17/Treg ratio were higher in the high titer group(P<0.05),while the Treg cell ratio was lower(P<0.05).GAM analysis results showed that higher the Th17 cell ratio(P<0.05),lower the Treg cell ratio(P<0.05),and higher the Th17/Treg ratio(P<0.05),higher the MP-IgM antibody titer.MP-IgM antibody titers,pleural effusion,neutrophil to lymphocyte ratio(NLR),D-dimer(D-D),Th17/Treg ratio,and duration of antibiotic treatment were all independent factors affecting poor prognosis(P<0.05).RCS analysis showed non-linear relationship between Th17/Treg ratio and the risk of poor prognosis(non-linear test P<0.001).The interaction analysis results showed that there was an additive interaction between Th17/Treg ratio(≥0.95)

关 键 词：肺炎支原体肺炎 辅助性T细胞17 调节性T细胞 抗体滴度 

分 类 号：R563.1[医药卫生—呼吸系统]