摘要
目的研究白细胞介素-8(IL-8)、白细胞介素-17(IL-17)、CD4-CD8比值(CD4+/CD8+)水平与儿童难治性支原体肺炎(RMPP)病情及预后的相关性。方法回顾性选取2017年1月至2019年7月在郑州大学附属儿童医院呼吸内科住院治疗的180例肺炎支原体肺炎(MPP)病儿中37例RMPP纳入RMPP组,其余143例普通MMP纳入轻型肺炎支原体肺炎(MMPP)组。比较两组病儿急性期IL-8、IL-17、CD4+/CD8+水平及其他实验室指标,logistic回归分析获得RMPP相关影响因素,绘制受试者工作特征(ROC)曲线分析logistic回归模型对RMPP的预测价值;依据支气管镜下表现评价预后,比较不同预后病人急性期血IL-8、IL-17、CD4+/CD8+水平。结果RMPP组病儿IL-8[(85.69±37.48)ng/L比(39.44±17.17)ng/L]、IL-17[(2.27±0.61)ng/L比(1.64±0.95)ng/L]、白细胞计数(WBC)、中性粒细胞计数(Neu)、血小板计数(PLT)、C反应蛋白(CRP)、红细胞沉降率(ESR)、乳酸脱氢酶(LDH)、纤维蛋白原(Fib)、D-二聚体显著高于MMPP组,RMPP组病儿CD4+/CD8+(0.92±0.22)显著低于MMPP组CD4+/CD8+(1.49±0.37)病儿(P<0.05);logistic回归分析显示IL-8、CRP、D-二聚体是RMPP的独立危险因素,CD4+/CD8+是保护因素;logistic回归模型预测RMPP的曲线下面积(AUC)为0.992,临界值>0.136,灵敏度、特异度分别为100.00%、96.50%;IL-8、CD4+/CD8+、CRP、D-二聚体的AUC分别为0.847、0.901、0.768、0.828,临界值分别为>70.71 ng/L、≤1.26 ng/L、>37.95 mg/L、>1.62 mg/L;恢复期RMPP组中29例接受支气管镜检查,13例恢复期预后不良的RMPP病儿IL-8显著高于16例预后良好病儿,CD4+/CD8+显著低于预后良好病儿(P<0.001),但IL-17比较差异无统计学意义(P>0.05)。结论IL-8、CD4+/CD8+可作为预测RMPP病情、预后的灵敏指标,但IL-17与RMPP病情及预后的关系仍有待探究。
Objective To study the correlation between interleukin-8(IL-8),interleukin-17(IL-17),CD4+/CD8+and the condition and prognosis of children with refractory mycoplasma pneumoniae pneumonia(RMPP).Methods One hundred and eighty children with mycoplasma pneumoniae pneumonia(MPP)who were hospitalized in the Department of Respiratory Medicine,Affiliated Chil-dren's Hospital of Zhengzhou University from January 2017 and July 2019 were retrospectively selected,including 37 cases with RM-PP(RMPP group)and 143 cases with common MMP[mild MPP(MMPP)group].IL-8,IL-17 and CD4+/CD8+levels and other laborato-ry indexes in acute phase were compared between the two groups.Logistic regression analysis was performed to obtain relevant influ-encing factors of RMPP,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of logistic re-gression model for RMPP.The prognosis was evaluated according to the performance under bronchoscope,and the blood IL-8,IL-17 and CD4+/CD8+levels in patients with different prognosis in acute phase were compared.Results IL-8[(85.69±37.48)ng/L vs.(39.44±17.17)ng/L],IL-17(2.27±0.61)ng/L vs.(1.64±0.95)ng/L,white blood cell count(WBC),neutrophil count(Neu),platelet count(PLT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),lactate dehydrogenase(LDH),fibrinogen(Fib)and D-dimer in RMPP group were significantly higher than those in MMPP group,while CD4+/CD8+(0.92±0.22)in RMPP group was significantly low-er than(1.49±0.37)of the MMPP group(P<0.05).Logistic regression analysis showed that IL-8,CRP and D-dimer were independent risk factors of RMPP,and CD4+/CD8+was a protective factor.Logistic regression model predicted that the Area under the Curve(AUC)of RMPP was 0.992,critical value was>0.136,the sensitivity and specificity were 100.00%and 96.50%,respectively.The AUC values of IL-8,CD4+/CD8+,CRP and D-dimer were 0.847,0.901,0.768 and 0.828,respectively.The critical values were>70.71 ng/L,≤1.26 ng/L,>37.95 mg/L and>1.62 mg/L,respectively.29 children in the RMPP group underwent bronchoscopy during the re-covery period.IL-8 in 13 children with poor prognosis was significantly higher than that in 16 children with good prognosis,while CD4+/CD8+was significantly lower than that of children with good prognosis(P<0.001).However,there was no statistically significant difference in IL-17(P>0.05).Conclusions IL-8 and CD4+/CD8+can be used as sensitive indexes to predict the condition and progno-sis of RMPP.The relationship between IL-17 and the condition and prognosis of RMPP needs further study.
作者
卢红霞
黄晗
郭燕军
梁利红
吴琳琳
张婷
LU Hongxia;HUANG Han;GUO Yanjun;LIANG Lihong;WU Linlin;ZHANG Ting(Department of Respiratory Medicine,Zhengzhou Children's Hospital,Henan Children's Hospital,Affiliated Children's Hospital of Zhengzhou University,Zhengzhou,Henan 450000,China)
出处
《安徽医药》
CAS
2021年第12期2411-2415,共5页
Anhui Medical and Pharmaceutical Journal
基金
2018年度河南省医学科技攻关计划(联合共建项目)(2018020665)。
