不同病原体感染肺炎患儿血清维生素D、IL-17A的表达差异及其临床意义探究  

Exploration of the Differential Expression of Serum Vitamin D and IL-17A in Children with Pneumonia Infected by Different Pathogens and Their Clinical Significance

作　　者：徐加威 吴晓凤 罗燕 蒋敏 丁洁银 XU Jia-wei;WU Xiao-feng;LUO Yan;JING Min;DING Jie-yin(Department of Pediatrics,Huaian Fifth People's Hospital,Huaian,Jiangsu,223000,China)

机构地区：[1]淮安市第五人民医院儿科,江苏淮安223000

出　　处：《现代生物医学进展》2025年第3期519-526,共8页Progress in Modern Biomedicine

基　　金：江苏省卫生科研课题(BJ23020)。

摘　　要：目的:探究不同病原体感染肺炎患儿血清25-(OH)D3、IL-17A的表达差异及其临床意义。方法:将2020年8月~2024年6月收治的240例不同病原体感染CAP患儿依照病原体类型分为病毒组(病毒性肺炎,40例)、支原体组(支原体肺炎,100例)及细菌组(细菌性肺炎,100例)。对比三组患儿血清维生素D、IL-17A表达差异。对240例肺炎患儿进行15 d随访,15 d内痊愈且无后遗症者分为预后良好组(n=210),15 d内未痊愈或合并严重后遗症者为预后不良组(n=30),比较两组一般资料,采用logistic回归模型分析预后影响因素,并建立预后受试者工作特征曲线(ROC)评价血清25-(OH)D3、IL-17A对肺炎的预后预测价值。结果:三组患儿最高体温、白细胞、中性粒细胞、CRP水平及PSI评分对比差异显著(P<0.05);比较三组患儿25-(OH)D3、IL-17A水平发现,25-(OH)D3由高到低为支原体组、病毒组、细菌组,IL-17A水平由高到低为病毒组、细菌组、支原体组,三组比较差异显著(P<0.05);不同预后情况肺炎患儿一般资料比较发现,不良预后组、良好预后组性别、年龄、BMI、白细胞、中性粒细胞、CRP水平对比无明显差异(P>0.05),不良预后组PSI评分、IL-17A水平高于良好预后组,25-(OH)D3水平低于良好预后组,两组比较差异显著(P<0.05);以肺炎预后情况作为因变量(预后良好=0,预后不良=1),纳入logistic回归模型,结果显示,PSI评分、25-(OH)D3、IL-17A对肺炎患儿预后水平具有独立预测价值(P<0.05);通过ROC曲线分析发现,血清25-(OH)D3联合IL-17A对小儿肺炎预后评估曲线下面积(AUC)为0.826,敏感度为85.65%,特异度为76.68%,均高于单独25-(OH)D3或IL-17A检测(P<0.05)。结论:不同病原体感染肺炎患儿血清25-(OH)D3、IL-17A的表达水平呈现显著差异,且血清维生素D、IL-17A水平与肺炎预后相关,二者联合检测可提升肺炎患儿预后判断的特异度及灵敏度。Objective:To investigate the differential expression and clinical significance of serum 25-(OH)D3 and IL-17A in children with pneumonia infected by different pathogens.Methods:240children with CAP infected with different pathogens admitted from August 2020 to June 2024 were divided into viral group(viral pneumonia,40 cases),mycoplasma group(mycoplasma pneumonia,100cases),and bacterial group(bacterial pneumonia,100 cases)according to the pathogen type.Compare the differences in serum vitamin D and IL-17A expression among three groups of pediatric patients.240children with pneumonia were followed up for 15 days.Those who recovered within 15 days without sequelae were divided into a good prognosis group(n=210),and those who did not recover within 15days or had severe sequelae were divided into a poor prognosis group(n=30).The general data of the two groups were compared,and a logistic regression model was used to analyze the prognostic factors.A receiver operating characteristic curve(ROC)was established to evaluate the prognostic value of serum25-(OH)D3 and IL-17A for pneumonia.Results:The highest body temperature,white blood cells,neutrophils,CRP level and PSI scores varied significantly among the three groups(P<0.05);Comparing the levels of 25-(OH)D3 and IL-17A in three groups of children,The levels of 25-(OH)D3 from high to low were classified as Mycoplasma group,Virus group,and Bacterial group,while the levels of IL-17A from high to low were classified as Virus group,Bacterial group,and Mycoplasma group.The differences among the three groups were significant(P<0.05);Comparing the general data of pneumonia patients with different prognoses,it was found that the poor prognosis group and the good prognosis group had gender,age BMI,There was no significant difference in the levels of white blood cells,neutrophils,and CRP(P>0.05).The PSI score and IL-17A level in the poor prognosis group were higher than those in the good prognosis group,and the 25-(OH)D3 level was lower than that in the good prognosis group.The dif

关 键 词：病毒性肺炎 支原体肺炎 细菌性肺炎 社区获得性肺炎 维生素D 白细胞介素-17A 

分 类 号：R3[医药卫生—基础医学] R725.6