肺炎支原体合并链球菌感染肺炎IL-10和IL-17及淋巴细胞亚群与预后的关系  

Relationship between IL-10,IL-17,lymphocyte subsets and prognosis of patienos with concurrent infections of Mycoplasma pneumoniac and streptococcus

作　　者：蒋欢欢 葛金林 曾余丰 JIANG Huanhuan;GE Jinlin;ZENG Yufeng(Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州市中西医结合医院呼吸与危重症医学科,浙江温州325000

出　　处：《中华医院感染学杂志》2025年第3期331-335,共5页Chinese Journal of Nosocomiology

基　　金：浙江省中医药科技计划基金资助项目(2023ZL167)

摘　　要：目的探讨肺炎支原体(MP)合并链球菌感染肺炎患者白细胞介素-10(IL-10)、IL-17、淋巴细胞亚群水平,及各指标与预后的关系。方法选取温州市中西医结合医院2021年1月—2023年12月收治的120例肺炎支原体肺炎(MPP)合并链球菌感染患者作为研究组,另外选取100名同期健康体检者作为健康组。依据出院随访2个月内患者的病情分为预后良好组94例和预后不良组26例。对比各组患者IL-10、IL-17和淋巴细胞亚群情况。采用Pearson相关性分析MPP合并链球菌感染肺炎患者外周血IL-10、IL17、淋巴细胞亚群与急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分和临床肺部感染评分(CPIS)的相关性。采用多因素logistic回归模型归纳MPP合并链球菌感染患者预后的因素。结果研究组IL-10、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)分别为(6.85±0.83)ng/L、(35.51±5.97)%和(1.23±0.39)低于健康组,IL-17和CD_(8)^(+)分别为(23.04±3.64)ng/L、(35.24±5.62)%高于健康组(P均<0.05)。预后不良组IL-10、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)低于预后良好组,IL-17和CD_(8)^(+)高于预后良好组(均P<0.05);预后不良组APACHEⅡ评分和CPIS均高于健康组(均P<0.05)。MPP合并链球菌感染患者IL-10、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)与APACHEⅡ评分呈负相关(r=-0.509、-0.502、-0.494,P均<0.001),与CPIS也呈负相关(r=-0.623、-0.630、-0.616,P均<0.001);IL-17、CD_(8)^(+)与APACHEⅡ评分呈正相关(r=0.494、0.505,P均<0.001),与CPIS也呈正相关(r=0.624、0.618,P均<0.001)。IL-17(OR=1.817,95%CI:1.074~3.072,P=0.026)、APACHEⅡ评分(OR=2.330,95%CI:1.254~4.329,P=0.008)是影响MPP合并链球菌感染患者预后的危险因素。结论MPP合并链球菌感染患者存在IL-10低表达、IL-17高表达及免疫失调情况,且其水平变化与病情及预后有相关性。IL-17表达水平、APACHEⅡ评分是影响MPP合并链球菌感染患者预后的危险因素。OBJECTIVE To explore the levels of interleukin-10(IL-10),IL-17,lymphocyte subsets in patients infected with Mycoplasma pneumoniae(MP)complicated with Streptococcus pneumoniae,as well as the relationship between each index and prognosis.METHODS One hundred and twenty patients with Mycoplasma pneumoniae pneumonia(MPP)complicated with Streptococcus infection in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from Jan.2021 to Dec.2023 were selected as the study group,and 100 healthy subjects with normal physical examination during the same period were included in healthy group.According to the disease conditions of patients within 2 months of discharge follow-up,the patients were divided into the good prognosis group with 94 cases and the poor prognosis group with 26 cases.The IL-10,IL-17 levels and lymphocyte subsets of patients in each group were compared.Pearson correlation analysis was used to explore the correlation between peripheral blood IL-10,IL-17,lymphocyte subsets and acute physiology and chronic health evaluationⅡ(APACHEⅡ)and clinical pulmonary infection score(CPIS)in patients with MPP complicated with Streptococcus infection.Multivariate logistic regression model was applied to analyze the factors affecting the prognosis of patients with MPP complicated with Streptococcus infection.RESULTS The levels of IL-10,CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)in the study group were(6.85±0.83)ng/L,(35.51±5.97)%and(1.23±0.39),respectively,lower than those in the healthy group,while the levels of IL-17 and CD+were(23.04±3.64)ng/L and(35.24±5.62)%,higher than those in the healthy group(all P<0.05).The IL-10,CD_(4)^(+)and CD_(4)^(+)/CD_(8)^(+)levels of the poor prognosis group were lower than those of the good prognosis group,while the levels of IL-17 and CD_(8)^(+)were higher than those of the good prognosis group(all P<0.05).The APACHEⅡscore and CPIS scores were higher in the poor prognosis group than in the healthy group(all P<0.05).IL-10,CD+and CD,+/CDs+in patients with MPP and Strept

关 键 词：支原体肺炎 链球菌感染 炎症反应 淋巴细胞亚群 预后 

分 类 号：R563.1[医药卫生—呼吸系统]