肺炎支原体感染合并喘息性支气管肺炎患儿临床特征

doi:10.3969/j.issn.1004-583X.2024.09.007

摘要/Abstract

摘要：

目的探讨肺炎支原体(Mycoplasma pneumoniae,MP)感染合并喘息性支气管肺炎患儿临床特征。方法选取2021年9月至2023年2月郑州大学附属儿童医院收治的50例MP感染合并喘息性支气管肺炎患儿为观察组,选取同期来我院就诊的50例MP感染但未合并喘息性支气管肺炎患儿为对照组。比较两组T淋巴细胞亚群(CD₃⁺、CD₄⁺、CD₈⁺)、免疫球蛋白[(免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白E(IgE)]、肺功能[肺活量(VC)、第1秒用力呼气容积(FEV₁)、用力肺活量(FVC)、峰值流速(PEF)、最大呼气中段流量(MMEF)]、血清炎症因子(TGF-β1、TNF-α)和补体C3水平。结果 ①观察组CD₃⁺、CD₄⁺、CD₈⁺水平均高于对照组(P<0.05)。②观察组IgG、IgM、IgE水平均高于对照组(P<0.05)。③观察组VC、FEV₁、FVC、PEF、MMEF水平均低于对照组(P<0.05)。④两组TGF-β1水平差异无统计学意义(P>0.05);观察组TNF-α、补体C3水平高于对照组(P<0.05)。结论 MP感染合并喘息性支气管肺炎患儿的免疫反应显著,肺功能降低,TNF-α和补体C3水平升高。

关键词: 肺炎, 支原体, 喘息性支气管肺炎, 儿童, T细胞淋巴亚群, 转化生长因子-β1, 补体C3

Abstract:

Objective To investigate the clinical characteristics of children with Mycoplasma pneumoniae (MP) infection complicated with asthmatic bronchopneumonia. Methods Fifty children with MP infection and asthmatic bronchopneumonia admitted to Children's Hospital Affiliated to Zhengzhou University from September 2021 to February 2023 were selected as the observation group, and 50 children with MP infection but not asthmatic bronchopneumonia during the same period were selected as the control group. The levels of T cell lymphocyte subsets (CD₃⁺, CD₄⁺, CD₈⁺), immunoglobulins (IgG, IgM and IgE), and lung function (vital capacity [VC], forced expiratory volume in the first second [FEV₁], forced vital capacity [FVC], peak expiratory flow [PEF], maximum mid-expiratory flow [MMEF]), serum inflammatory factors (transforming growth factor-beta1 [TGF-β1], tumor necrosis factor alpha [TNF-α]), and complement C3 levels were compared. Results The levels of CD₃⁺, CD₄⁺, CD₈⁺ in the observation group were significantly higher than those of control group (p<0.05). IgG, IgM, and IgE levels in the observation group were significantly higher than the control group (P<0.05). The levels of VC, FEV₁, FVC, PEF and MMEF in the observation group were significantly lower than those of control group (P<0.05). The levels of TNF-α and complement C3 in the observation group were significantly higher than those of control group (P<0.05). There was no significant difference in TGF-β1 level between the two groups (P>0.05). Conclusion Children with MP infection and asthmatic bronchopneumonia have a significant immune response, reduced pulmonary function, and increased levels of TNF-α and complement C3.

Key words: pneumonia, Mycoplasma, asthmatic bronchopneumonia, child, T cell lymphocyte subsets, transforming growth factor-β1, complement C3

中图分类号:

R563.1

杨晓琳, 杨妍. 肺炎支原体感染合并喘息性支气管肺炎患儿临床特征[J]. 临床荟萃, 2024, 39(9): 808-811.

Yang Xiaolin, Yang Yan. Clinical characteristics of children with Mycoplasma pneumoniae infection complicated with asthmatic bronchopneumonia[J]. Clinical Focus, 2024, 39(9): 808-811.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.09.007

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I9/808

图/表 5

表1 两组一般资料比较

Tab.1 General data between the two groups

组别	例数	性别[例(%)]		年龄(岁)	体重(kg)	身高(cm)
组别	例数	男	女	年龄(岁)	体重(kg)	身高(cm)
观察组	50	26(52.00)	24(48.00)	8.12±3.51	15.68±5.04	136.03±35.27
对照组	50	28(56.00)	22(44.00)	8.28±3.64	16.19±5.97	135.66±34.84
$t$ /χ²值		1.161		-0.224	-0.462	0.053
P值		0.688		0.823	0.645	0.958

表1 两组一般资料比较

Tab.1 General data between the two groups

组别	例数	性别[例(%)]		年龄(岁)	体重(kg)	身高(cm)
组别	例数	男	女	年龄(岁)	体重(kg)	身高(cm)
观察组	50	26(52.00)	24(48.00)	8.12±3.51	15.68±5.04	136.03±35.27
对照组	50	28(56.00)	22(44.00)	8.28±3.64	16.19±5.97	135.66±34.84
$t$ /χ²值		1.161		-0.224	-0.462	0.053
P值		0.688		0.823	0.645	0.958

表2 两组T细胞亚群比较

Tab.2 T cell subsets between the two groups

组别	例数	C $D 3 +$ (%)	C $D 4 +$ (%)	C $D 8 +$ (%)
观察组	50	75.81±12.46	39.55±8.54	29.74±6.38
对照组	50	62.57±9.23	34.28±7.17	25.47±4.36
$t$ 值		6.038	3.342	3.907
P值		0.000	0.001	0.000

表2 两组T细胞亚群比较

Tab.2 T cell subsets between the two groups

组别	例数	C $D 3 +$ (%)	C $D 4 +$ (%)	C $D 8 +$ (%)
观察组	50	75.81±12.46	39.55±8.54	29.74±6.38
对照组	50	62.57±9.23	34.28±7.17	25.47±4.36
$t$ 值		6.038	3.342	3.907
P值		0.000	0.001	0.000

表3 两组免疫球蛋白比较

Tab.3 Immunoglobulin levels between the two groups

组别	例数	IgG(g/L)	IgM(g/L)	IgE(g/L)
观察组	50	12.54±3.47	1.82±0.54	127.34±15.08
对照组	50	10.45±4.01	1.63±0.39	106.46±13.34
$t$ 值		2.787	2.017	7.333
P值		0.006	0.046	0.000

表3 两组免疫球蛋白比较

Tab.3 Immunoglobulin levels between the two groups

组别	例数	IgG(g/L)	IgM(g/L)	IgE(g/L)
观察组	50	12.54±3.47	1.82±0.54	127.34±15.08
对照组	50	10.45±4.01	1.63±0.39	106.46±13.34
$t$ 值		2.787	2.017	7.333
P值		0.006	0.046	0.000

表4 两组肺功能比较

Tab.4 Pulmonary function between the two groups

组别	例数	VC(ml)	FEV₁(%)	FVC(%)	PEF(%)	MMEF(%)
观察组	50	63.58±7.49	44.36±10.58	63.32±7.96	53.61±8.21	44.65±8.62
对照组	50	82.71±13.58	64.29±14.06	81.94±15.83	72.54±10.37	73.12±15.43
$t$ 值		-8.722	-8.009	-2.830	-10.120	-11.390
P值		0.000	0.000	0.006	0.000	0.000

表4 两组肺功能比较

Tab.4 Pulmonary function between the two groups

组别	例数	VC(ml)	FEV₁(%)	FVC(%)	PEF(%)	MMEF(%)
观察组	50	63.58±7.49	44.36±10.58	63.32±7.96	53.61±8.21	44.65±8.62
对照组	50	82.71±13.58	64.29±14.06	81.94±15.83	72.54±10.37	73.12±15.43
$t$ 值		-8.722	-8.009	-2.830	-10.120	-11.390
P值		0.000	0.000	0.006	0.000	0.000

表5 两组血清炎症因子、补体C3比较

Tab.5 Levels of serum inflammatory factors and complement C3 between the two groups

组别	例数	TGF-β1 (pg/ml)	TNF-α (pg/ml)	补体C3 (g/L)
观察组	50	31.67±4.78	4.65±1.69	1.97±0.58
对照组	50	32.24±4.36	4.08±1.08	1.71±0.54
$t$ 值		-0.623	2.010	2.320
P值		0.535	0.047	0.022

表5 两组血清炎症因子、补体C3比较

Tab.5 Levels of serum inflammatory factors and complement C3 between the two groups

组别	例数	TGF-β1 (pg/ml)	TNF-α (pg/ml)	补体C3 (g/L)
观察组	50	31.67±4.78	4.65±1.69	1.97±0.58
对照组	50	32.24±4.36	4.08±1.08	1.71±0.54
$t$ 值		-0.623	2.010	2.320
P值		0.535	0.047	0.022

参考文献 20

[1]	Tong L, Huang S, Zheng C, et al. Refractory Mycoplasma pneumoniae pneumonia in children: Early recognition and management[J]. J Clin Med, 2022, 11(10):2824.
[2]	罗国兰, 李梦薇, 朱虹贞, 等. 合并细菌感染的喘息性支气管肺炎患儿临床特征分析[J]. 检验医学与临床, 2022, 19(20):2747-2750, 2754.
[3]	Liu M, Zhang Y, Hu Y, et al. The upregulation of peripheral CD3^-CD56⁺CD16⁺ natural killer cells correlates with Th1/Th2 imbalance in asthma patients during acute upper respiratory viral infections[J]. BMC Immunol, 2023, 24(1):40.
[4]	Kwizera R, Bongomin F, Olum R, et al. Evaluation of an Aspergillus IgG/IgM lateral flow assay for serodiagnosis of fungal asthma in Uganda[J]. PLoS One, 2021, 16(5):e0252553.
[5]	张倩, 乔赟, 时宜蓉, 等. 基于TGF-β1/Smad3信号通路探讨针刺抗哮喘气道重塑的作用机制[J]. 中国针灸, 2023, 43(6):684-690.
[6]	覃军, 陈玲, 邓蓉蓉, 等. 肺炎支原体肺炎合并哮喘患儿血清维生素D、CD5L、补体C3、IgE水平变化及与病情和炎症反应程度的关系[J]. 中国现代医学杂志, 2023, 33(23):10-15.
[7]	邱在军, 邱荣军, 吴星慧, 等. 血清DcR3、PD-L1水平与支气管哮喘儿童肺功能的相关性及其诊断价值[J]. 中国现代医学杂志, 2023, 33(18):96-100.
[8]	中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童支气管哮喘诊断与防治指南(2016年版)[J]. 中华儿科杂志, 2016, 54(3):167-181.
[9]	毛千芊, 谷晓阳. 诸福棠与《诸福棠实用儿科学》[J]. 中国卫生人才, 2023, (7):56-58.
[10]	蒋中英. 喘息性支气管炎和喘息性支气管肺炎儿童过敏原呼吸道炎症指标及肺功能检测情况[J]. 中国妇幼保健, 2022, 37(10):1828-1831.
[11]	Zhang L, Lai M, Ai T, et al. Analysis of Mycoplasma pneumoniae infection among children with respiratory tract infections in hospital in Chengdu from 2014 to 2020[J]. Transl Pediatr, 2021, 10(4):990-997. doi: 10.21037/tp-21-139 pmid: 34012847
[12]	林雪芹, 林君飞, 周巧敏, 等. 支气管哮喘合并肺炎支原体感染患儿血清炎性因子及免疫功能变化[J]. 中国基层医药, 2020, 27(19):2361-2364.
[13]	Mirijello A, La Marca A, D'Errico MM, et al. Venous thromboembolism during Mycoplasma pneumoniae infection: Case report and review of the literature[J]. Eur Rev Med Pharmacol Sci, 2020, 24(19):10061-10068.
[14]	Mo M, Wang J, Gu H, et al. Intestinal microbes-based analysis of immune mechanism of childhood asthma[J]. Cell Mol Biol (Noisy-le-grand), 2022, 68(2):70-80. doi: 10.14715/cmb/2022.68.2.11 pmid: 35869726
[15]	盖娜, 王琰华, 王潇健, 等. 血清骨膜蛋白、微小RNA-155与支气管哮喘急性发作期患儿肺功能和免疫功能及预后相关性研究[J]. 陕西医学杂志, 2023, 52(12):1684-1687.
[16]	何凤, 赵丹, 王城, 等. 脉冲震荡肺功能检测在小儿支气管哮喘诊疗中的应用价值[J]. 临床和实验医学杂志, 2023, 22(5):533-536.
[17]	徐晓梅, 舒冬冬, 李莉, 等. FeNO、NLR联合肺功能对哮喘急性发作患者病情评估的预测价值[J]. 分子诊断与治疗杂志, 2023, 15(4):639-642.
[18]	陈玲, 胡荆江, 覃军. 维生素D3辅助糖皮质激素对小儿支气管哮喘TLR4/NF-κB信号通路相关因子水平的影响[J]. 中国现代医学杂志, 2023, 33(14):22-27.
[19]	张丽娟, 任苓苓, 王令敏, 等. 宣肺解痉方治疗支气管哮喘的临床疗效及对血清TGF-β1、MMP-9、TNF-α水平的影响[J]. 辽宁中医杂志, 2022, 49(4):50-54.
[20]	易爽, 庞侯旭, 袁程远, 等. 肥胖型支气管哮喘患儿血Clara细胞分泌蛋白及补体C3和C4水平与病情严重程度的相关性分析[J]. 实用医院临床杂志, 2021, 18(3):146-149.