肺炎支原体感染不同病期婴幼儿免疫功能及炎症因子的动态变化
|
摘要
目的探讨肺炎支原体感染不同病期婴幼儿免疫功能及炎症因子水平的动态变化。方法选取深圳市龙华区中心医院2016年4月至2018年4月收治的80例肺炎支原体感染不同病期婴幼儿作为观察对象,其中急性期组和恢复期组各40例,选取同期体检的40例健康儿童作为对照组。分别对各组婴幼儿的免疫球蛋白及补体、外周血T淋巴细胞亚群及细胞炎症因子水平进行比较。结果各组患儿免疫球蛋白(IgG、IgM和IgA)及补体(C3和C4)水平差异具有统计学意义(F=5.902、2.936、3.187、2.059、3.786,P=0.000、0.011、0.008、0.021、0.004),其中恢复期组患儿IgG水平为(10.30±2.27)g/L,显著高于急性期组和对照组(t=3.203、3.044,P均<0.001),急性期组患儿IgM、C3、C4显著高于对照组和恢复期组(P均<0.05),急性期组与恢复期组患儿IgA水平显著低于对照组(t=2.565、P=0.021,t=2.752、P=0.018)。各组患儿T淋巴细胞亚群(CD3~+、CD4~+、CD8~+、CD4/CD8)、NK细胞差异均具有统计学意义(F=8.602、9.031、8.917、4.281、4.335,P均<0.001),其中急性期组和恢复期组患儿CD3~+、CD4~+、CD4/CD8和NK细胞水平均显著低于对照组(P均<0.05),急性期组和恢复期组患儿CD8~+T分别为(35.53±5.33)%和(30.47±4.17)%,显著高于对照组(27.81±4.51)%(t=3.742、P <0.001,t=2.184、P=0.028),且急性期组患儿CD8~+、CD4/CD8、NK细胞与恢复期组差异具有统计学意义(t=2.770、2.337、2.182,P=0.020、0.023、0.024)。各组患儿细胞炎症因子(hBD-1、hBD-2、TNF-α、IL-8、IL-10和IL-13)水平差异具有统计学意义(P均<0.001),其中急性期组与恢复期组患儿TNF-α、IL-8、IL-10和IL-13显著高于对照组(P均<0.05),而hBD-1显著低于对照组(t=3.583、P <0.001,t=3.192、P=0.001),急性期组患儿TNF-α、IL-8、IL-10和IL-13显著高于恢复期组(P均<0.05)。结论肺炎支原体感染病患儿存在免疫功能缺陷和炎症因子水平异常,临床诊疗中应予以重视。
Objective To investigate the dynamic changes of immune function and inflammatory factors in infants with mycoplasma pneumonia infection. Methods From April 2016 to April 2018, a total of80 infants with mycoplasma pneumonia infection were selected as observation subjects, including 40 cases in acute stage group and 40 cases in convalescence stage group, while 40 healthy children were selected as control group. Results There were significant differences in levels of immunoglobulin(IgG, IgM and IgA)and complement(C3 and C4) among the groups(F = 5.902, 2.936, 3.187, 2.059, 3.786; P = 0.000, 0.011,0.008, 0.021, 0.004). The level of IgG in convalescent group was(10.30 ± 2.27) g/L, which was significantly higher than that of acute phase group and control group(t = 3.203, 3.044; both P < 0.001). Levels of IgM,C3 and C4 were significantly higher than those of control group and convalescence group(all P < 0.05).IgA level in acute phase group and convalescence group were significantly lower than that of control group(t = 2.565, P = 0.021; t = 2.752, P = 0.018). The difference of T lymphocyte subsets(CD3, CD4, CD8, CD4/CD8) and NK cells were statistically significant in each group(F = 8.602, 9.031, 8.917, 4.281, 4.335; all P <0.001), the levels of CD3, CD4, CD4/CD8 and NK cells of acute phase group and convalescence group were significantly lower than those of control group(all P < 0.05). Levels of CD8+ T of acute phase group and convalescence group were(35.53 ± 5.33)% and(30.47 ± 4.17)%, respectively, which were significantly higher than those of control group [(27.81 ± 4.51)%](t = 3.742, P < 0.001; t = 2.184, P = 0.028), and the difference of CD8, CD4/CD8, NK cells in acute phase group and convalescent group were significantly different(t =2.770, 2.337, 2.182; P = 0.020, 0.023, 0.024). The levels of cytokines(hBD-1, hBD-2, TNF-α, IL-8, IL-10 and IL-13) were significantly different in each group(all P < 0.001), the levels of TNF-α, IL-8, IL-10 and IL-13 in acute phase group and convalescence group were significantly higher than those of control group(all P <0.001), but level of HBD-1 was significantly lower than that of the control group(t = 3.583, P < 0.001; t =3.192, P = 0.001); the levels of TNF-α, IL-8, IL-10 and IL-13 in acute phase group were significantly higher than those of convalescence group(all P < 0.05). Conclusions The children with mycoplasma pneumonia infection have the deficiency of immune function and abnormal level of inflammatory factors, which should be paid more attention in clinical diagnosis and treatment.
Objective To investigate the dynamic changes of immune function and inflammatory factors in infants with mycoplasma pneumonia infection. Methods From April 2016 to April 2018, a total of80 infants with mycoplasma pneumonia infection were selected as observation subjects, including 40 cases in acute stage group and 40 cases in convalescence stage group, while 40 healthy children were selected as control group. Results There were significant differences in levels of immunoglobulin(IgG, IgM and IgA)and complement(C3 and C4) among the groups(F = 5.902, 2.936, 3.187, 2.059, 3.786; P = 0.000, 0.011,0.008, 0.021, 0.004). The level of IgG in convalescent group was(10.30 ± 2.27) g/L, which was significantly higher than that of acute phase group and control group(t = 3.203, 3.044; both P < 0.001). Levels of IgM,C3 and C4 were significantly higher than those of control group and convalescence group(all P < 0.05).IgA level in acute phase group and convalescence group were significantly lower than that of control group(t = 2.565, P = 0.021; t = 2.752, P = 0.018). The difference of T lymphocyte subsets(CD3, CD4, CD8, CD4/CD8) and NK cells were statistically significant in each group(F = 8.602, 9.031, 8.917, 4.281, 4.335; all P <0.001), the levels of CD3, CD4, CD4/CD8 and NK cells of acute phase group and convalescence group were significantly lower than those of control group(all P < 0.05). Levels of CD8+ T of acute phase group and convalescence group were(35.53 ± 5.33)% and(30.47 ± 4.17)%, respectively, which were significantly higher than those of control group [(27.81 ± 4.51)%](t = 3.742, P < 0.001; t = 2.184, P = 0.028), and the difference of CD8, CD4/CD8, NK cells in acute phase group and convalescent group were significantly different(t =2.770, 2.337, 2.182; P = 0.020, 0.023, 0.024). The levels of cytokines(hBD-1, hBD-2, TNF-α, IL-8, IL-10 and IL-13) were significantly different in each group(all P < 0.001), the levels of TNF-α, IL-8, IL-10 and IL-13 in acute phase group and convalescence group were significantly higher than those of control group(all P <0.001), but level of HBD-1 was significantly lower than that of the control group(t = 3.583, P < 0.001; t =3.192, P = 0.001); the levels of TNF-α, IL-8, IL-10 and IL-13 in acute phase group were significantly higher than those of convalescence group(all P < 0.05). Conclusions The children with mycoplasma pneumonia infection have the deficiency of immune function and abnormal level of inflammatory factors, which should be paid more attention in clinical diagnosis and treatment.
引文
[1]甄乾娜,张磊,王兴斌.外周血T淋巴细胞亚群和细胞因子在儿童肺炎支原体肺炎诊断中的意义[J].检验医学与临床,2017,14(8):1060-1062.
[2]陈映辉.阿奇霉素序贯疗法合痰热清治疗支原体肺炎临床疗效及安全性研究[J].现代中西医结合杂志,2016,25(14):1570-1571.
[3]张秀英,胡玲,赵国华,等.小儿肺热咳喘颗粒治疗儿童支气管肺炎的临床观察[J].中草药,2016,47(11):1931-1934.
[4]Wang L,Chen Q,Shi C,et al.Changes of serum TNF-α,IL-5 and IgE levels in the patients of mycoplasma pneumonia infection with or without bronchial asthma.[J].Int J Clin Exp Med,2015,8(3):3901.
[5]Lienau J,Müller-Redetzky H,Suttorp N,et al.New pathogenetic concepts and pharmacological studies on adjuvant therapy in severe pneumonia[J].Pneumologie,2016,70(6):372-378.
[6]Le W,Feng Z,Zhao M,et al.A comparison study between GeXP-based multiplex-PCR and serology assay for Mycoplasma pneumoniae detection in children with community acquired pneumonia[J].BMCInfect Dis,2017,17(1):518.
[7]贾云霞,杨晓丽.肺炎支原体肺炎患儿临床特点及血清白细胞介素-18变化及意义[J].中国药物与临床,2016,16(10):1513-1515.
[8]付晓燕,辛徳莉,秦选光.儿童肺炎支原体感染流行病学,临床特点,发病机制及治疗研究进展[J].山东医药,2015,55(4):96-99.
[9]楼兰芳,李小兵,张兰青.小儿肺炎支原体感染后血清免疫球蛋白、红细胞免疫及外周血T淋巴细胞亚群的变化情况分析[J].中国妇幼保健,2015,30(3):385-387.
[10]王绪栋,林荣军,王学山,等.肺炎支原体感染引起的小儿肺炎支原体肺炎与细胞因子的相关性分析[J].国际呼吸杂志,2015,34(10):746-748.
[11]Tomari K,Morino S,Horikoshi Y.The first case of infantile legionella pneumonia after bathing in reheated and reused water[J].Pediatr Infect Dis J,2017,37(4):370-372.
[12]张爱明,郑梅.血常规,CRP和PCT在婴幼儿感染性疾病早期诊断中的临床价值[J].现代中西医结合杂志,2015,24(2):187-188.
[13]梁民锋.儿童肺炎支原体感染流行病学,临床特点,发病机制及治疗研究进展[J].世界最新医学信息文摘,2016,16(92):34-35.
[14]李万琼.阿奇霉素联合布地奈德混悬液雾化吸入治疗小儿肺炎支原体肺炎体会[J].贵州医药,2016,40(10):1080-1081.
[15]高群英,袁纯,丁国标.阿奇霉素序贯疗法治疗学龄前儿童肺炎支原体感染的疗效,安全性及对炎性因子水平的影响[J].现代中西医结合杂志,2015,24(32):3549-3551.
[16]李艳红,陈永森.不同肺炎支原体感染病期婴幼儿免疫功能及炎症因子的动态变化[J].海南医学院学报,2017,23(2):240-243.
[17]刘开云,刘欢,张融,等.儿童社区获得性肺炎不同临床类型外周血β-防御素1水平的表达[J].中国感染与化疗杂志,2018,18(1):44-47.
[18]Li X,Duan D,Yang J,et al.The expression of humanβ-defensins(hBD-1,hBD-2,hBD-3,hBD-4)in gingival epithelia[J].Arch Oral Biol,2016,66:15-21.
[19]Nishikawa A,Mimura K,Kanagawa T,et al.Thrombocytopenia associated with Mycoplasma pneumonia during pregnancy:Case presentation and approach for differential diagnosis[J].J Obstet Gynaecol Res,2015,41(8):1273-1277.
[20]赵德育,陈慧中,杨倩媛,等.临床征象对识别儿童社区获得性肺炎支原体肺炎价值的系统综述[J].中华儿科杂志,2016,54(2):104-110.
[21]孙诗炜.布地奈德联合可必特雾化吸入辅助治疗小儿肺炎支原体肺炎的疗效及对C反应蛋白的影响[J].实用临床医药杂志,2016,20(19):150-151.
[22]于春琳,赵德育.肺炎支原体肺炎免疫功能与其病情的相关性[J].江苏医药,2017,43(19):1388-1390.
[23]杨香红,李艳莉,罗春玉.肺炎支原体肺炎患儿免疫功能的变化及其与病情程度和疾病分期的关系[J].实用临床医药杂志,2016,20(7):113-116.
[24]崔亚利,陈丽珠,陈永传.小儿肺炎支原体感染诊治研究进展[J].海南医学,2016,27(9):1486-1488.
[25]李沫民,柳旎,张淼,等.肺炎支原体感染患儿的免疫水平研究[J].中华医院感染学杂志,2017,27(16):3795-3797.
[2]陈映辉.阿奇霉素序贯疗法合痰热清治疗支原体肺炎临床疗效及安全性研究[J].现代中西医结合杂志,2016,25(14):1570-1571.
[3]张秀英,胡玲,赵国华,等.小儿肺热咳喘颗粒治疗儿童支气管肺炎的临床观察[J].中草药,2016,47(11):1931-1934.
[4]Wang L,Chen Q,Shi C,et al.Changes of serum TNF-α,IL-5 and IgE levels in the patients of mycoplasma pneumonia infection with or without bronchial asthma.[J].Int J Clin Exp Med,2015,8(3):3901.
[5]Lienau J,Müller-Redetzky H,Suttorp N,et al.New pathogenetic concepts and pharmacological studies on adjuvant therapy in severe pneumonia[J].Pneumologie,2016,70(6):372-378.
[6]Le W,Feng Z,Zhao M,et al.A comparison study between GeXP-based multiplex-PCR and serology assay for Mycoplasma pneumoniae detection in children with community acquired pneumonia[J].BMCInfect Dis,2017,17(1):518.
[7]贾云霞,杨晓丽.肺炎支原体肺炎患儿临床特点及血清白细胞介素-18变化及意义[J].中国药物与临床,2016,16(10):1513-1515.
[8]付晓燕,辛徳莉,秦选光.儿童肺炎支原体感染流行病学,临床特点,发病机制及治疗研究进展[J].山东医药,2015,55(4):96-99.
[9]楼兰芳,李小兵,张兰青.小儿肺炎支原体感染后血清免疫球蛋白、红细胞免疫及外周血T淋巴细胞亚群的变化情况分析[J].中国妇幼保健,2015,30(3):385-387.
[10]王绪栋,林荣军,王学山,等.肺炎支原体感染引起的小儿肺炎支原体肺炎与细胞因子的相关性分析[J].国际呼吸杂志,2015,34(10):746-748.
[11]Tomari K,Morino S,Horikoshi Y.The first case of infantile legionella pneumonia after bathing in reheated and reused water[J].Pediatr Infect Dis J,2017,37(4):370-372.
[12]张爱明,郑梅.血常规,CRP和PCT在婴幼儿感染性疾病早期诊断中的临床价值[J].现代中西医结合杂志,2015,24(2):187-188.
[13]梁民锋.儿童肺炎支原体感染流行病学,临床特点,发病机制及治疗研究进展[J].世界最新医学信息文摘,2016,16(92):34-35.
[14]李万琼.阿奇霉素联合布地奈德混悬液雾化吸入治疗小儿肺炎支原体肺炎体会[J].贵州医药,2016,40(10):1080-1081.
[15]高群英,袁纯,丁国标.阿奇霉素序贯疗法治疗学龄前儿童肺炎支原体感染的疗效,安全性及对炎性因子水平的影响[J].现代中西医结合杂志,2015,24(32):3549-3551.
[16]李艳红,陈永森.不同肺炎支原体感染病期婴幼儿免疫功能及炎症因子的动态变化[J].海南医学院学报,2017,23(2):240-243.
[17]刘开云,刘欢,张融,等.儿童社区获得性肺炎不同临床类型外周血β-防御素1水平的表达[J].中国感染与化疗杂志,2018,18(1):44-47.
[18]Li X,Duan D,Yang J,et al.The expression of humanβ-defensins(hBD-1,hBD-2,hBD-3,hBD-4)in gingival epithelia[J].Arch Oral Biol,2016,66:15-21.
[19]Nishikawa A,Mimura K,Kanagawa T,et al.Thrombocytopenia associated with Mycoplasma pneumonia during pregnancy:Case presentation and approach for differential diagnosis[J].J Obstet Gynaecol Res,2015,41(8):1273-1277.
[20]赵德育,陈慧中,杨倩媛,等.临床征象对识别儿童社区获得性肺炎支原体肺炎价值的系统综述[J].中华儿科杂志,2016,54(2):104-110.
[21]孙诗炜.布地奈德联合可必特雾化吸入辅助治疗小儿肺炎支原体肺炎的疗效及对C反应蛋白的影响[J].实用临床医药杂志,2016,20(19):150-151.
[22]于春琳,赵德育.肺炎支原体肺炎免疫功能与其病情的相关性[J].江苏医药,2017,43(19):1388-1390.
[23]杨香红,李艳莉,罗春玉.肺炎支原体肺炎患儿免疫功能的变化及其与病情程度和疾病分期的关系[J].实用临床医药杂志,2016,20(7):113-116.
[24]崔亚利,陈丽珠,陈永传.小儿肺炎支原体感染诊治研究进展[J].海南医学,2016,27(9):1486-1488.
[25]李沫民,柳旎,张淼,等.肺炎支原体感染患儿的免疫水平研究[J].中华医院感染学杂志,2017,27(16):3795-3797.