儿童肺炎支原体肺炎不同感染状态下外周血淋巴细胞亚群的特征分析  

Characteristics of peripheral blood lymphocyte subsets in children with mycoplasma pneumoniae pneumonia under different infection states

作　　者：黎锦[1] 卓广政 郭爽[1] 杨桂[1] 潘运宝 李一荣[1] Li Jin;Zhuo Guangzheng;Guo Shuang;Yang Gui;Pan Yunbao;Li Yirong(Department of Laboratory Medicine,Zhongnan Hospital of Wuhan University,Hubei Provincial Clinical Research Center for Molecular Diagnostics,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院医学检验科,湖北省分子诊断临床医学研究中心,武汉430071

出　　处：《中华预防医学杂志》2025年第3期344-351,共8页Chinese Journal of Preventive Medicine

基　　金：湖北省科技厅重点研发计划(2022BCA019)。

摘　　要：本研究探讨儿童肺炎支原体肺炎(MPP)不同感染状态下外周血淋巴细胞亚群的特征。采用回顾性横断面研究,选取2023年10月至2024年1月武汉大学中南医院收治的肺炎患儿共194例作为研究对象,女性91例,男性103例,年龄范围是7个月至13岁。根据肺炎患儿感染病原体类型分为单纯肺炎支原体感染组(80例)、非支原体感染组(29例)和混合病原体感染组(85例);根据MP 23S rRNA基因突变结果,MPP患儿分为耐药组(112例)和非耐药组(53例);根据支气管镜检查和影像学检查结果,MPP患儿分为重症组(35例)和轻症组(130例)。分析各组病原体感染情况、外周血淋巴细胞亚群百分比和绝对计数、hsCRP、IFN-γ、TNF-α、IL-10、IL-4、IL-6和IL-2检测值,比较多组间检测项目差异性。采用受试者工作曲线(ROC)评估外周血淋巴细胞亚群检测在儿童MPP中的诊断价值。结果显示,MPP患儿合并感染率为51.51%(85/165),合并感染中肺炎链球菌例数最多(39/85,45.88%),其次为流感嗜血杆菌(26/85,30.89%);MPP患儿中MP耐药基因突变率为67.88%(112/165)。三组感染类型比较,单纯支原体组和混合病原体组的CD3^(+)(1164,1285个/μl)、CD3^(+)CD4^(+)(612,694个/μl)、CD3^(+)CD8^(+)(415,457个/μl)、CD3^(-)CD19^(+)(242,313个/μl)、CD3^(-)CD16^(+)CD56^(+)(168,176个/μl)和CD3^(+)CD16^(+)CD56^(+)(50,52个/μl)的中位数均明显低于非支原体组(2092,1037,660,541,295,86个/μl)(P<0.05);耐药组与非耐药组间各检测指标无明显差异(P˃0.05);重症组CD3^(+)CD4^(+)%(34.91)和CD3^(-)CD16^(+)CD56^(+)绝对计数(148个/μl)明显低于轻症组(37.91,187个/μl),CD3^(-)CD19^(+)%(19.48)明显高于轻症组(16.33)(P<0.05)。参考健康儿童淋巴细胞亚群检测参考区间[9]的年龄段划分,单纯支原体组患儿中4~8岁41例,9~12岁29例;上述两个年龄段CD3^(+)(1093,925个/μl)、CD3^(+)CD4^(+)(576,543个/μl)、CD3^(+)CD8^(+)(401,356个/μl)、CD3^(-)CD19^(+)(238,234个/μl)和CD3^(-)CD16^(+)CThe research investigated the characteristics of lymphocyte subsets in peripheral blood of children with mycoplasma pneumoniae pneumonia in different infection states.The retrospective cross-sectional study selected 194 children with pneumonia from October 2023 to January 2024 in Zhongnan Hospital of Wuhan University as the study objects,patients aged 7 months to 13 years old,including 91 female children and 103 male children.According to the types of pathogens,the children with pneumonia were divided into single MP infection group(80 cases),non-MP infection group(29 cases)and mixed pathogen infection group(85 cases).According to the mutation of MP23S rRNA gene,the MPP children were divided into drug-resistance group(112 cases)and non-drug-resistance group(53 cases).According to the results of bronchoscopy and imaging,the MPP children were divided into severe group(35 cases)and mild group(130 cases).Pathogen infection,the percentage and absolute count of lymphocyte subsets in peripheral blood,hypersensitive CRP,interferon-γ,tumor necrosis factor-α,interleukin-10,interleukin-4,interleukin-6 and interleukin-2 in each group were analyzed retrospectively.The levels of the test items in each group were compared.The value of peripheral blood lymphocyte subsets in the diagnosis of MPP in children was evaluated by ROC curve.The results showed that the co-infection rate of MPP children was 51.51%(85/165).Streptococcus pneumoniae was the most common co-infection(39/85,45.88%),followed by Haemophilus influenzae(26/85,30.89%).The mutation rate of MP resistance gene was 67.88%(112/165)in MPP children tested for tNGS in bronchoalveolar lavage fluid.The absolute counts(cells/μl)of CD3^(+),CD3^(+)CD4^(+),CD3^(+)CD8^(+),CD3^(-)CD19^(+),CD3^(-)CD16^(+)CD56^(+)and CD3^(+)CD16^(+)CD56^(+)in the simple MP group(1164,612,415,242,168,50)and the mixed pathogen group(1285,694,457,313,176,52)were significantly lower than those in the non-MP group(2092,1037,660,541,295,86)(P<0.05).There was no significant difference between drug-resista

关 键 词：肺炎支原体肺炎 儿童 外周血淋巴细胞亚群 耐药支原体感染 合并感染 

分 类 号：R725.6[医药卫生—儿科]