摘要
目的分析不同血清学指标对肺炎支原体肺炎(Mycoplasmal pneumoniae pneumonia,MPP)患儿预后不良的预测价值。方法选取2018年7月至2020年2月于徐州医科大学附属徐州儿童医院住院的MPP患儿100例为研究对象,按照疾病严重程度将其分别纳入重症组(50例)和普通组(50例),另选取该院同期体检健康儿童50例纳入对照组,分别检测重症组和普通组患儿急性期和恢复期血清红细胞沉降率(erythrocyte sedimentation rate,ESR)和D-二聚体(D-dimer,DD)、乳酸脱氢酶(lactate dehydrogenase,LDH)、T细胞亚群(CD3^+T细胞、CD4^+T细胞、CD8^+T细胞)、同型半胱氨酸(homocysteine,Hcy)、白介素-6(interleukin-6,IL-6)、γ干扰素(interferon-gamma,IFN-γ)水平,计算CD4^+T细胞/CD8^+T细胞比值,并与对照组进行比较。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析上述血清学指标对MPP患儿预后不良的预测价值。结果在急性期和恢复期,重症组患儿血清ESR和DD、LDH、Hcy、IL-6、IFN-γ水平均显著高于普通组(均P<0.05),且两组患儿上述指标水平均显著高于对照组(均P<0.05);重症组患儿血清CD3^+T细胞、CD4^+T细胞水平和CD4^+T细胞/CD8^+T细胞比值均显著低于普通组(均P<0.05),且两组患儿上述指标水平均显著低于对照组(均P<0.05)。随访6个月后,100例MPP患儿预后不良25例,预后良好75例。预后不良组患儿血清ESR和DD、LDH、Hcy、IL-6、IFN-γ水平均显著高于预后良好组(均P<0.05),CD3^+T细胞和CD4^+T细胞水平均显著低于预后良好组(均P<0.05)。多因素Logistic回归分析显示:血清ESR、DD、LDH、CD3^+T细胞、CD4^+T细胞、Hcy、IL-6和IFN-γ均是MPP患儿预后的独立影响因素(均P<0.05)。血清ESR和DD、LDH、CD3^+T细胞、CD4^+T细胞、Hcy、IL-6、IFN-γ水平预测MPP患儿预后不良的曲线下面积分别为0.76、0.79、0.81、0.69、0.72、0.84、0.72和0.80。结论血清ESR和DD、LDH、CD3^+T细胞、CD4^+T细胞、Hcy、IL-6、IFN-γ水平对MPP患儿预后有一定的预测价值。
Objective To investigate the predictive value of different serological indexes on poor prognosis in children with Mycoplasma pneumoniae pneumonia(MPP).Method One hundred children with MPP who were hospitalized in Xuzhou Children's Hospital,Xuzhou Medical University from July 2018 to February 2020 were selected as subjects,they were divided into severe disease group(n=50)and ordinary group(n=50)according to the severity of the disease.Another 50 healthy children who were examined in the hospital during the same period were included in control group.The serum erythrocyte sedimentation rate(ESR)and the levels of D-dimer(DD),lactate dehydrogenase(LDH),T cell subset(CD3^+T cell,CD4^+T cell,CD8^+T cell),homocysteine(Hcy),interleukin-6(IL-6),interferon-gamma(IFN-γ)in acute and convalescent stages were measured in severe group and ordinary group,respectively,and compared with the control group.The value of the above serological indexes in predicting the poor prognosis of children with MPP was analyzed by receiver operating characteristic curve(ROC curve).Result In the acute and convalescent stages,the serum ESR,and the levels of DD,LDH,Hcy,IL-6,IFN-γin severe group were significantly higher than those in ordinary group(all P<0.05),and the levels of the above indexes in the two groups were significantly higher than those in control group(all P<0.05).The levels of serum CD3^+T cells,CD4^+T cells and the ratio of CD4^+T cells/CD8^+T cells in severe group were significantly lower than those in ordinary group(all P<0.05),and the levels of the above indexes in the two groups were significantly lower than those in control group(all P<0.05).After 6 months of follow-up,25 of the 100 children with MPP had a poor prognosis and 75 had a good prognosis.The serum ESR,and the levels of DD,LDH,Hcy,IL-6,IFN-γ in poor prognosis group were significantly higher than those in good prognosis group(all P<0.05),while the levels of CD3+T cells and CD4+T cells in poor prognosis group were significantly lower than those in good prognosis group(all P<0.05).Multivariate Logistic regression analysis showed that serum ESR,DD,LDH,CD3^+T cells,CD4^+T cells,Hcy,IL-6 and IFN-γ were independent prognostic factors in children with MPP(all P<0.05).The area under the curve of serum ESR,and the levels of DD,LDH,CD3^+T cells,CD4^+T cells,Hcy,IL-6,IFN-γ to predict poor prognosis in children with MPP were 0.76,0.79,0.81,0.69,0.72,0.84,0.72 and 0.80,respectively.Conclusion The serum ESR and the levels of DD,LDH,CD3^+T cells,CD4^+T cells,Hcy,IL-6,IFN-γ are of certain value in predicting the prognosis of children with MPP.
作者
刘冉
武怡
Liu Ran;Wu Yi(Department of Respiratory Medicine,Xuzhou Children's Hospital,Xuzhou Medical University,Jiangsu,Xuzhou 221000,China;Department of Pediatrics,the Affiliated Hospital of Xuzhou Medical University,Jiangsu,Xuzhou 221000,China)
出处
《中国医学前沿杂志（电子版）》
2020年第11期116-120,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
作者简介
通信作者:武怡,E-mail:wuyi7809@163.com。
