甲型流感病毒合并肺炎支原体感染患儿淋巴细胞亚群和炎性细胞因子变化与肺炎严重程度的相关性  

Correlations of lymphocyte subsets and inflammatory cytokines with pneumonia severity in children with influenza A virus and Mycoplasma pneumoniae co-infection

作　　者：付书琴[1] 贾婉玉 宋春兰 李鹏[1] 成怡冰 FU Shuqin;JIA Wanyu;SONG Chunlan;LI Peng;CHENG Yibing(Department of Emergency Medicine,Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Children's Hospital,Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care,Zhengzhou,Henan 450o0,China)

机构地区：[1]郑州大学附属儿童医院/河南省儿童医院郑州儿童医院急诊医学科/河南省儿童感染与危重症诊治工程研究中心,河南郑州450000

出　　处：《中华实用诊断与治疗杂志》2025年第3期238-243,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关联合共建项目(LHGJ20220734);河南省医学科技攻关省部共建项目(SB201903028)。

摘　　要：目的 观察甲型流感病毒(IAV)合并肺炎支原体(MP)感染患儿外周血淋巴细胞亚群、炎性细胞因子水平变化,探讨其与肺炎严重程度的相关性。方法 2023年3月—2024年5月河南省儿童医院诊治IAV合并MP感染患儿240例,未发生肺炎者120例为无肺炎组,发生肺炎者120例参照临床肺部感染评分分为重症感染组33例和轻度感染组87例。比较3组入院次日外周血CD3^(+)T淋巴细胞百分比、CD4^(+)/CD8^(+)比值、CD19^(+)B淋巴细胞百分比、自然杀伤(NK)细胞百分比及血清白细胞介素(IL)-4、IL-5、IL-6、IL-8、IL-10、IL-17a、肿瘤坏死因子-α(TNF-α)、干扰素(IFN)-α、IFN-γ水平;采用Spearman相关法分析CD3^(+)T淋巴细胞百分比、CD4^(+)/CD8^(+)比值及IL-6、IL-10、IL-4、IFN-γ与肺炎严重程度的相关性。结果 (1)3组CD3^(+)T淋巴细胞百分比、CD4^(+)/CD8^(+)比值及CD19^(+)B淋巴细胞百分比比较差异均有统计学意义(H=6.574~71.531,P均<0.05),NK细胞百分比比较差异无统计学意义(H=1.749,P=0.417)。重症感染组CD3^(+)T淋巴细胞百分比[50.62%(47.17%,55.31%)]、CD4^(+)/CD8^(+)比值[0.83(0.63,1.75)]均低于轻度感染组[54.17%(50.65%,61.44%)、1.36(0.82,1.69)]和无肺炎组[67.17%(62.35%,73.35%)、1.38(1.09,1.73)](P<0.05),轻度感染组均低于无肺炎组(P<0.05);无肺炎组CD19^(+)B淋巴细胞百分比[(23.24±6.49)%]低于轻度感染组[(25.32±7.65)%]和重症感染组[(28.77±7.54)%](P<0.05),轻度感染组与重症感染组比较差异无统计学意义(P>0.05)。(2)3组血清IL-4、IL-6、IL-10、IFN-γ水平比较差异均有统计学意义(H=6.574~69.080,P均<0.05),IL-5、IL-8、TNF-α、IFN-α、IL-17a水平比较差异均无统计学意义(H=2.626~6.832,P均>0.05)。重症感染组血清IL-4[3.46(2.37,4.31)ng/L]、IL-6[37.4(30.89,64.23)ng/L]、IL-10[32.44(19.69,52.86)ng/L]、IFN-γ[2.72(1.18,4.04)ng/L]水平均高于轻度感染组[2.65(1.57,4.15)、19.57(5.19,37.78)、24.07(8.99,40.62)、2.50(1.53,4.22)ng/L]和无肺炎组[2.18Objective To observe the changes of lymphocyte subsets and inflammatory cytokine levels in peripheral blood of children who were co-infected with influenza A virus(IAV)and Mycoplasma pneumoniae(MP),and to explore their correlations with the severity of pneumonia.Methods Totally 240 children with IAV and MP co-infection were diagnosed and treated in Henan Children's Hospital from March 2023 to May 2024,among whom 120 children without pneumonia were assigned to the non-pneumonia group,and the other 120 children with pneumonia were further divided into the severe infection group(n=33)and the mild infection group(n=87)according to the clinical pulmonary infection score.The peripheral blood CD3^(+)T lymphocyte percentage,CD4^(+)/CD8^(+)ratio,CD19^(+)B lymphocyte percentage,natural killer(NK)cell percentage,and serum levels of interleukin(IL)-4,IL-5,IL-6,IL-8,IL-10,IL-17a,tumor necrosis factor-α(TNF-α),interferon(IFN)-α,and IFN-γwere compared among three groups on the second day of admission.Spearman correlation method was used to analyze the correlations of the severity of pneumonia with CD3^(+)T lymphocyte percentage,CD4^(+)/CD8^(+)ratio,IL-6,IL-10,IL-4 and IFN-γ.Results(1)There were significant differences in the CD3^(+)T lymphocyte percentage,CD4^(+)/CD8^(+)ratio,and CD19^(+)B lymphocyte percentage among three groups(H=6.574-71.531,all P values<0.05),while the NK cell percentage showed no significant difference(H=1.749,P=0.417).The CD3^(+)T lymphocyte percentage and CD4^(+)/CD8^(+)ratio were lower in the severe infection group[50.62%(47.17%,55.31%),0.83(0.63,1.75)]than those in the mild infection group[54.17%(50.65%,61.44%),1.36(0.82,1.69)]and the non-pneumonia group[67.17%(62.35%,73.35%),1.38(1.09,1.73)](P<0.05),and were lower in the mild infection group than those in the non-pneumonia group(P<0.05).The CD19^(+)B lymphocyte percentage was lower in the non-pneumonia group[(23.24±6.49)%]than that in the mild infection group[(25.32±7.65)%]and the severe infection group[(28.77±7.54)%](P<0.05),and showed no sig

关 键 词：甲型流感病毒 肺炎支原体 儿童 T淋巴细胞亚群 炎性细胞因子 自然杀伤细胞 

分 类 号：R725.6[医药卫生—儿科]