儿童肺炎支原体肺炎血清细胞因子变化及临床意义

目的 探讨肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)患儿血清细胞因子水平的变化及临床意义.方法 选择2008年1月至2009年12月我院儿内科收治的MPP患儿239例为MPP组,根据病情的严重程度再分为轻症MPP组(n=152)和重症MPP组(n=87).选择同期收治的急性支气管肺炎患儿263例为非MPP组.选择同期在儿外科住院的疝气和包皮过长择期手术患儿共50例作为对照组.所有肺炎患儿均于入院第1天进行肺炎支原体抗体检测和细胞因子肿瘤坏死因子(TNF)-α、γ干扰素(IFN-γ)、白细胞介素(IL)-1β、IL-4、IL-6]检测,患儿经治疗感染恢复期重新留取血清复查以上指标；对照组留取1次血清,检测细胞因子水平.结果 MPP组和非MPP组患儿血清TNF-α、IL-1β、IL-6水平均高于对照组(P＜0.01)；而IFN-γ、IL-4水平3组间比较差异无统计学意义(P ＞0.05)；MPP组血清IFN-γ、IL-1β水平及IFN-γ/IL-4比值高于非MPP组(P＜0.01)；MPP组恢复期TNF-α、IL-1β、IL-6水平和IFN-γ/IL-4比值较急性期明显降低(P ＜0.001,P＜0.05)；重症MPP组血清TNF-a、IL-1β水平及IFN-γ、IL-4比值明显高于轻症MPP组(P＜0.01).结论 MPP患儿存在免疫功能紊乱,血清中TNF-α、IL-1β、IL-6水平及IFN-γ/IL-4比值与病情严重程度相关,可用来评估病情.

The changes of serum cytokines in children with mycoplasma pneumoniae pneumonia

Objective To investigate the changes of serum cytokines in children with mycoplasma pneumoniae pneumonia (MPP).Methods A total of 239 children with MPP hospitalized in our department from Jan 2008 to Dec 2009 served as MPP group,which were redivided into mild MPP group (n =152) and severe MPP group ( n =87 ).Two hundred and sixty-three acute bronchopneumonia children without MPP infection served as non-MPP group.Fifty cases who would undergo hernia and phimosis elective surgery in pediatric surgery department served as control group.All children with pneumonia were detected mycoplasma pneumoniae antibodies and cytokines (TNF-α,IFN-γ,IL-1β,IL-4,IL-6) of serum in the first day of hospitalization and recovery period.Children in control group were detected the level of cytokines only once.Results Serum levels of TNF-α,IL-1β,IL-6 in MPP group and non-MPP group were higher than those in　control group ( P ＜ 0.01 ).No significant differences of IFN-γ and IL-4 levels were found among three groups ( P ＞ 0.05 ).Compared with non-MPP group,the levels of IFN-γ,IL-1β and IFN-γ/IL-4 were higher in MPP group ( P ＜ 0.01 ).The levels of TNF-α,IL- 1β,IL-6,and IFN-γ/IL-4 were significantly decreased in　the recovery period of MPP (P ＜0.001,P ＜ 0.05 ).The levels of TNF-α,IL-1β and IFN-γ/IL-4 in severe　MPP children were higher than those in mild MPP children ( P ＜ 0.01 ).Conclusion The immunologic　function of MPP children is unbalanced.The serum levels of TNF-α,IL-1β,IL-6,and IFN-γ/IL-4 are correlated with severity of MPP,which help to evaluate the state of MPP.