重症肺炎支原体肺炎CD3+HLA-DR表达与VitA水平相关性分析

  目的   探讨重症肺炎支原体肺炎外周血淋巴细胞CD3+HLA-DR表达、血清Vitamin A（VitA）水平及其相关性。  方法   回顾性分析2017年1月至2020年12月入住昆明医科大学第二附属医院儿科病房,符合重症肺炎支原体肺炎诊断标准的24例患儿,随机选取同期住院的普通肺炎支原体肺炎47例为普通组;单纯上呼吸道感染、身材矮小症住院的23例为对照组;入院次日晨采集空腹静脉血,其中非抗凝血1 mL和抗凝血3 mL送检;肺炎支原体抗体滴度测定选用微量血被动凝集法,CD19,CD4,CD8,CD3+HLA-DR选用美国贝曼流式细胞仪及试剂测定,血清VitA检测:采用高效液相色谱法;统计学分析:采用单因素方差分析,两两比较采用LSD-t检验;相关性分析采用 Pearson 分析;危险因素采用Logistic分析。  结果  （1） 重症肺炎支原体肺炎者 24 例,男14 例、女 10 例,年龄（4.97±1.79）岁;普通肺炎支原体肺炎者 47 例,男30 例、女 17 例,平均年龄（4.87±1.79）岁;同期单纯上呼吸道感染、身材矮小症住院的23例患儿,男12例、女11 例,平均年龄（4.77±2.11）岁,3组患儿年龄、性别比较,差异无统计学意义（P > 0.05） ;（2）3组患儿CD19,CD4,CD8,CD3+HLA-DR,VitA值比较:重症组淋巴细胞CD4,CD3+HLA-DR表达及血清VitA水平明显降低[（34.2±4.54）,（11.83±2.57）,（0.23±0.10）],CD19（18.66±2.56）明显增高,与普通组[（38.1±4.04）,（17.11±2.71）,（0.33±0.14）]和对照组[（39.35±3.86）,18.78±1.86）,0.40±0.14）]比较,差异有统计学意义（P < 0.05）;VitA与CD4,CD3+HLA-DR正相关（r = 0.371,0.688,P < 0.05）;Logistic回归分析结果显示,血清VitA水平、CD3+HLA-DR表达的下降均是SMMP的独立危险因素（OR = 4.42、2.38,P < 0.05）。  结论  淋巴细胞活化参与了MPP的发生发展,过强的免疫反应不仅会诱发过分的免疫反应,而且还会导致自身免疫损伤（免疫麻痹）,重症发生的基础,推测VitA也参与调控淋巴细胞的活化。

Correlation between CD3+ HLA-DR Expression and Vita Level in Severe Mycoplasma Pneumoniae Pneumonia

  Objective   To investigate the expression of CD3 + HLA-DR in peripheral blood lymphocytes and the level of serum VitA in severe Mycoplasma pneumoniae pneumonia.   Methods   24 children who met the diagnostic criteria of severe Mycoplasma pneumoniae pneumonia admitted to the pediatric ward of our hospital from January 2017 to December 2020 were analyzed retrospectively. 47 cases of common Mycoplasma pneumoniae pneumonia hospitalized in the same period were randomly selected as the general group; 23 patients with simple upper respiratory tract infection and short stature were the control group; Fasting venous blood was collected in the morning of the next day after the admission, including non anticoagulant 1ml and anticoagulant 3ml; The antibody titer of Mycoplasma pneumoniae was determined by micro blood passive agglutination method, CD19, CD4, CD8, CD3 + HLA-DR was determined by American Berman flow cytometry and reagent, and serum VA was detected by high performance liquid chromatography; Statistical analysis: one-way ANOVA was used, and LSD-t test was used for pairwise comparison; Pearson analysis was used for correlation analysis; The risk factors were analyzed by logistic analysis.   Results   1. There were 24 cases of severe Mycoplasma pneumoniae pneumonia, 14 males and 10 females, aged （4.97 ± 1.79） years; There were 47 cases of Mycoplasma pneumoniae pneumonia, 30 males and 17 females, with an average age of （4.87 ± 1.79） years; In the same period, there were 23 hospitalized children with simple upper respiratory tract infection and short stature, including 12 males and 11 females, with an average age of （4.77 ± 2.11） years. There was no significant difference in age and gender among the three groups （P > 0.05）; 2. Comparison of CD19, CD4, CD8, CD3 + HLA-DR and vita values among the three groups: the expression of CD4, CD3 + HLA-DR and serum Vita levels in lymphocytes of the severe group were significantly lower （34.2 ± 4.54, 11.83 ± 2.57, 0.23 ± 0.10）, CD19 （18.66 ± 2.56） increased significantly, which was significantly higher than that in the general group [38.1 ± 4.04, 17.11 ± 2.71, 0.33 ± 0.14] and the control group （39.35 ± 3.86, 18.78 ± 1.86, 0.40 ± 0.14） （P < 0.05）; Vita was positively correlated with CD4, CD3 + HLA-DR （r = 0.371, 0.688, P < 0.05）. The results of logistic regression analysis showed that the decrease of serum Vita level and CD3 + HLA-DR expression were independent risk factors of SMMP （or = 4.42, 2.38, P < 0.05）.   Conclusion  lymphocyte activation was involved in the occurrence and development of MPP. Excessive immune response would not only induce excessive immune response, but also lead to autoimmune injury （immune paralysis）. It is speculated that VitA is also involved in regulating lymphocyte activation.