目的: 观察儿童肺炎支原体肺炎的临床特征,探讨社区获得性呼吸窘迫综合征毒素(CARDS TX)及血清IL-1β的表达等因素在肺炎支原体肺炎发病中的作用。方法: 选取本院2019年1月—2020年1月住院的社区获得性肺炎患儿120例为研究对象,分为重症支原体肺炎组(SMPP)(30例)、非重症支原体肺炎组(NSMPP)(50例)及非支原体肺炎组 (NMPP)(40例);所有研究对象检测支气管灌洗液CARDS TX水平及外周静脉血IL-1β、血生化、炎症指标、凝血功能等。结果: (1)CARDS TX和IL-1β:SMPP组明显高于NSMPP组,NSMPP组均高于NMPP组,差异均有统计学意义(P＜0.05);(2)乳酸脱氢酶(LDH):SMPP组明显高于NSMPP和NMPP组,差异均有统计学意义(P＜0.05);(3)炎性指标:C反应蛋白(CRP)和铁蛋白SMPP组明显高于NMPP组;降钙素原(PCT)NMPP组高于SMPP和NSMPP组,差异均有统计学意义(P＜0.05);(4)凝血指标:凝血酶原时间(PT)、PT活动度(PT%)、部分凝血酶原时间(APTT)在SMPP组明显短于NSMPP组,又短于NMPP组;纤维蛋白原(FIB)SMPP组高于NSMPP,又高于NMPP组;D-二聚体(D-Di)SMPP组高于NSMPP、NMPP组,差异均有统计学意义(P＜0.05)。结论: (1)CARDS TX可导致呼吸道损伤,同时诱导炎症因子IL-1β的产生增加,临床上可以通过CARDS TX的检测对支原体肺炎进行诊断,为进一步有针对性的治疗提供理论依据;(2)支原体感染后存在较严重的机体炎症反应,为抗炎治疗提供有力证据;(3)支原体感染时存在高凝血功能异常,是导致支原体感染出现血栓的原因,是引起支原体感染难治和重症的影响因素。
Objective: To observe the clinical characteristics of mycoplasma pneumoniae pneumonia in children, and to explore the role of community acquired respiratory distress syndrome toxin (CARDS TX) and serum IL-1β expression in the pathogenesis of mycoplasma pneumoniae pneumonia. Methods: A total of 120 children with community-acquired pneumonia hospitalized in our hospital from 2019 to 2020 were selected as the research objects and divided into severe mycoplasma pneumonia group (SMPP, 30 cases), non-severe mycoplasma pneumonia group (NSMPP, 50 cases) and non-mycoplasma pneumonia group (NMPP, 40 cases). All subjects underwent bronchial lavage fluid CARDS TX levels and peripheral venous blood IL-1β, blood biochemistry, inflammatory markers, coagulation function test. Results: (1) The levels of CARDS TX and IL-1β in SMPP group were higher than those in NSMPP group, and those in NSMPP group were higher than those in NMPP group, the differences were statistically significant (P＜0.05). (2) The level of lactate dehydrogenase (LDH) in SMPP group was higher than that in NSMPP and NMPP groups, and the differences were statistically significant (P＜0.05). (3) The levels of C-reactive protein (CRP) and ferritin in SMPP group were higher than those in NMPP group, and the level of procalcitonin (PCT) in NMPP group was higher than those in SMPP and NSMPP groups, the differences were statistically significant (P＜0.05). (4) Prothrombin time (PT), PT activity (PT%) and partial prothrombin time (APTT) in SMPP group were shorter than those in NSMPP group and NMPP group; the fibrinogen (FIB) in SMPP group was higher than that in NSMPP group and higher than that in NMPP group; the D-dimer (D-Di) in SMPP group was higher than that in NSMPP and NMPP groups, and the differences were statistically significant (P＜0.05). Conclusion: (1) CARDS TX can lead to respiratory tract injury, and increase the production of inflammatory cytokines IL-1β. Clinically, mycoplasma pneumonia can be diagnosed by CARDS TX detection, which provides a theoretical basis for further targeted treatment. (2) Severe inflammatory reaction after mycoplasma infection provides strong evidence for anti-inflammatory treatment. (3) High coagulation dysfunction in mycoplasma infection is the cause of thrombosis in mycoplasma infection, which is the influencing factor of refractory and severe mycoplasma infection.
[1] Michelow IC, Olsen K, Lozano J, et al.Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children[J].Pediatrics, 2004, 113(4):701-707.
[2] Defilippi A, Silvestri M, Tacchella A, et al.Epidemiology and clinical features of Mycoplasma pneumoniae inflection in children[J].Resp Med, 2008, 102(12):1762-1768.
[3] Lenglet A, Herrador Z, Magiorakors AP, et al.Surveillance status and recent data for Mycoplasma pneumoniae inflection in the European Union and European Economic Area, January 2012 [J]. Eurosurveillance, 2012, 17(5):20075.
[4] 邓聪, 曾海生, 邓朝晖, 等.吴川市儿童肺炎支原体感染情况分析[J].中国校医, 2015, 4(29):266-268.
[5] 沈丽娟, 王金龙, 陈桂峰, 等.儿童社区获得性肺炎临床特征与大环内脂类抗生素疗效分析[J]. 临床儿科杂志, 2013, 4(31):331-334.
[6] 中华医学会儿科学分会呼吸学组与编辑委员会, 中华儿科杂志.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志, 2013, 51(11):856-862.
[7] 江载芳, 申昆玲, 沈颖.诸福棠实用儿科学[M].8版.北京:人民卫生出版社, 2015:1281-1285.
[8] 国家卫生计生委合理用药专家委员会儿童用药专业组.中国儿童肺炎支原体感染实验室诊断规范和临床实践专家共识(2019年)[J].中华儿科杂志, 2020, 58(5):366-373.
[9] Waites K B, Xiao L, Liu Y, et al.Mycoplasma pneumoniae from the respiratory tract and beyond[J].Clin Microbiol Rev, 2017, 30(3):747-809.
[10] 拜世英, 马艳红.儿童肺炎支原体肺炎并发血栓形成的早期识别和诊治[J].临床儿科杂志, 2016, 34(10):792-795.
[11] Somarajan S, Al-Asadi F, Ramasamy K, et al. Annexin A2 mediates Mycoplasma pneumoniae community-acquired respiratory distress syndrome toxin binding to eukaryotic cells[J]. MBio, 2014, 5( 4) : e01497-14.
[12] Maenpuen S, Wattaisong P, Supon P, et al, Kinetic mechanism of L-alpha-glycerophosphate oxidase from Mycoplasma pneumoniae[J].FEBS J, 2015, 282(16):3043-3059.
[13] Becker A, Kannan TR, Taylor AB, et al.Structure of CARDS toxin, a unique ADP-ribosylating and vacuolating cytotoxin from Mycoplasma pneumoniae[J]. Proc Natl Acad Sci USA, 2015, 112(16):5165-5170.
[14] Sato T, Okamura T, Kojima-Shibata C, et al.Correlated response of peripheral blood cytokines with selection for reduced Mycoplasma pneumonia of swine lesions in Landrace pigs[J].Anim Sci J, 2016, 87(4): 477-483.
[15] Liu F, Zhang X, Zhang B, et al.TREM1:A postitive regulator for inflammatory response via NF-kappaB pathway in A549 cells infected with Mycoplasma pneumpniae[J].Biomed Pharmacotyer, 2018, 107:1466-1472.
[16] Maselli DJ, Medina JL, Brooks EG, et al.The immunopathologic effects of Mycoplasma pneumoniae and community-acquired respiratory distress syndrome toxin, A Primate Model[J].Am J Respir Cell Mol Biol, 2018, 58(2): 253-260.
[17] 仇娟, 曹玲.肝素在儿童重症肺炎中的应用[J].中国医刊, 2019, 54(3):254-258.
[18] Mulloy B, Hpgwood J, Gray E, et al.Pharmacology of heparin and related drugs[J].Pharmacol Rev, 2016, 68(1):76-141.
[19] Glas GJ, Van Der Sluijs KF, Schultz MJ, et al.Bronchoalveolar hemostasis in lung injury and acute respiratory distress syndrome[J]. JThromb Haemost, 2013, 11(1):17-25.
[20] 郑雪香, 林继雷, 代继宏.基于决策曲线和计量反应分析评估乳酸脱氢酶对儿童难治性肺炎支原体肺炎的预测价值[J].中国当代儿科杂志, 2020, 22(2):112-117.
[21] 李光远, 罗明鑫, 谢启莲.难治性支原体肺炎患儿早期乳酸脱氢酶、T细胞亚群的检测及临床意义[J].临床儿科杂志, 2017, 22(7):1276-1278.
[22] Tashiro M, Fushimi K, Kawano K, et al.Adjunctive corticosteroid therapy for inpatients with Mycoplasma pneumoniae pneumonia[J].BMC Pulmonary Med, 2017, 17(1):219.
