难治性支原体肺炎患儿血清D-二聚体、IL-21和TLR2表达及其临床诊断价值  

Expression of D-dimer,IL-21 and TLR2 in serum of children with refractory myeoplasma pneumoniae pneumonia and their clinical diagnostic value

作　　者：高建波[1] 李娜[1] 郑伟伟[1] 许丽萍 GAO Jian-bo;LI Na;ZHENG Wei-wei;XU Li-ping(Department of Pediatrics,People's Hospital of Jiyuan,Jiyuan,Henan 459000,China;Department of Respiratory Medicine,Henan Provincial Children's Hospital,Zhengzhou Children's Hospital,Zhengzhou 450053,China)

机构地区：[1]济源市人民医院儿科,河南济源459000 [2]河南省儿童医院,郑州儿童医院呼吸科,郑州450053

出　　处：《医药论坛杂志》2025年第3期333-337,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210647)。

摘　　要：目的探讨难治性支原体肺炎(refractory myeoplasma pneumoniae pneumonia,RMPP)患儿血清D-二聚体(D-dimer,D-D)、白介素-21(interleukin-21,IL-21)及Toll样受体2(toll-like receptor 2,TLR2)表达及其临床诊断价值。方法选取2020年7月至2022年10月济源市人民医院收治的186例支原体肺炎患儿,依照临床诊断划分为普通支原体肺炎(general mycoplasma pneumoniae pneumonia,GMPP)组(n=140)、RMPP组(n=46)。对比两组患儿一般资料、血清D-D、IL-21、TLR2、肿瘤坏死因子-α、降钙素原及C反应蛋白水平。logistic回归分析影响RMPP发生的独立危险因素。制作受试者工作特征(receiver operating characteristic,ROC)曲线,评估血清D-D、IL-21、TLR2及三者联合对RMPP的诊断价值。结果GMPP组、RMPP组年龄、性别、体重指数、体温、病程比较差异无统计学意义(P>0.05);RMPP组血清D-D、IL-21、TLR2、降钙素原、C反应蛋白水平均高于GMPP组,差异有统计学意义(t=7.678、7.057、5.394、14.896、25.786,均P<0.05),两组间肿瘤坏死因子-α水平对比,差异无统计学意义(P>0.05)。多因素回归分析结果显示,血清D-D(OR=4.096,95%CI:2.056~8.161)、IL-21(OR=2.778,95%CI:1.424~5.418)、TLR2(OR=5.016,95%CI:2.441~10.307)、降钙素原(OR=1.243,95%CI:1.013~1.524)及C反应蛋白(OR=1.161,95%CI:1.008~1.338)为RMPP的独立危险因素(P<0.05)。ROC曲线结果显示,血清D-D、IL-21、TLR2及三者联合对RMPP诊断的曲线下面积(area under curve,AUC)分别为0.802(95%CI:0.737~0.857)、0.787(95%CI:0.721~0.844)、0.751(95%CI:0.683~0.812)、0.899(95%CI:0.847~0.938)。结论血清D-D、IL-21、TLR2三者联合检测对RMPP患儿的诊断效能较高,可为临床医师判定患儿病情、制订治疗方案提供依据。Objective To investigate the expression of D-dimer(D-D),interleukin-21(IL-21)and Toll-like receptor 2(TLR2)in serum of children with refractory myeoplasma pneumoniae pneumonia(RMPP)and their clinical diagnostic value.Methods Totally 186 children with mycoplasma pneumonia admitted to Jiyuan People's Hospital from July 2020 to October 2022 were divided into two groups according to the clinical diagnosis:general mycoplasma pneumonia(GMPP)group(n=140)and RMPP group(n=46).The general data,serum levels of D-D,IL-21,TLR2,tumor necrosis factor-α,procalcitonin and C-reactive protein were compared between the two groups.Logistic multivariate regression analysis was used to analyze the independent risk factors affecting the occurrence of RMPP.ROC curve was made to evaluated the diagnostic value of serum D-D,IL-21,TLR2 and their combination in RMPP.Results There were no significant differences in age,sex,body mass index,body temperature and course of disease between GMPP group and RMPP group(P>0.05).The serum levels of D-D,IL-21,TLR2,procalcitonin and C-reactive protein in RMPP group were higher(t=7.678,7.057,5.394,14.896,25.786,P<0.05),and there was no statistical difference between the two groups(P>0.05).The results of multifactorial regression analysis showed that serum D-D(OR=4.096,95%CI:2.056-8.161),IL-21(OR=2.778,95%CI:1.424-5.418),TLR2(OR=5.016,95%CI:2.441-10.307),procalcitonin(OR=1.243,95%CI:1.013-1.524)and C-reactive protein(OR=1.161,95%CI:1.008-1.338)were independent risk factors for RMPP(P<0.05).The results of ROC curve showed that the AUC of serum D-D,IL-21,TLR2 and the combination of the three for the diagnosis of RMPP were 0.802(95%CI:0.737-0.857),0.787(95%CI:0.721-0.844)and 0.751(95%CI:0.683-0.812),0.899(95%CI:0.847-0.938),respectively.Conclusion The combination of serum D-D,IL-21,and TLR2 has high diagnostic efficacy for children with RMPP,which can provide a basis for clinicians to determine the condition of the children and formulate treatment plans.

关 键 词：难治性支原体肺炎 普通支原体肺炎 D-二聚体 白介素-21 TOLL样受体2 诊断价值 

分 类 号：R725.6[医药卫生—儿科]