儿童肺炎支原体肺炎肺泡灌洗液中T细胞亚群及细胞因子检测的意义

目的 探讨肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)患儿支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中,白细胞介素(interleukin,IL)-6、单核细胞趋化因子(monocyte chemotactic protein,MCP)-1、干扰素(interferon,IFN)-γ及T 细胞亚群的水平及临床意义.方法 选取2014年10月至2016年3月在我院住院的36例肺炎患儿,按诊断标准分为难治性肺炎支原体肺炎(refractory mycoplasma pneumoniae pneumonia,RMPP)组(18例)和MPP组(18例),及同期收治的支气管异物患儿16例作为对照组.分别采用双抗体夹心ELISA法及碱性磷酸酶-抗碱性磷酸酶(APAAP)桥联酶标法测定3组患儿BALF中的IL-6、MCP-1、IFN-γ及T细胞亚群水平.结果 (1) MPP组及RMPP组急性期患儿的BALF中,CD3 +、CD8 +T细胞水平高于对照组(P<0.05),但两组急性期间比较差异无统计学意义(P >0.05).(2)RMPP 组急性期 IL-6水平高于对照组(P <0.05), RMPP 组及MPP组急性期IL-6水平高于恢复期(P<0.05).(3)RMPP组急性期及 MPP组急性期IFN-γ水平均高于对照组,3组间比较差异有统计学意义(P<0.05),且RMPP组急性期较MPP组急性期明显升高(P<0.05),RMPP组恢复期高于MPP组恢复期.(4)RMPP组急性期及MPP组急性期MCP-1水平高于对照组(P<0.05),且RMPP组急性期高于MPP组急性期,RMPP组恢复期高于MPP组恢复期,RMPP组急性期及MPP组急性期MCP-1水平均分别高于恢复期(P<0.05).结论 肺炎支原体感染后,患儿存在细胞免疫调节及功能的紊乱;IL-6、MCP-1及IFN-γ是重要的细胞因子,可能参与了MPP 的发病过程,并且IFN-γ及MCP-1可作为预测MPP难治性的重要指标.

The clinical significance of T-cell subset,cytokine levels in bronchoalveolar lavage fluid of children with mycoplasma pneumoniae pneumonia

Objective To explore the levels and clinical significances of T-cell subset,interleukin (IL)-6,interferon(IFN)-γ,and monocyte chemotactic protein(MCP)-1 in bronchoalveolar lavage fluid (BALF) of children with mycoplasma pneumoniae pneumonia(MPP).Methods Thirty-six children with pneumonia were admitted in our hospital from October 2014 to March 2016.They were divided into refractory mycoplasma pneumoniae pneumonia (RMPP) group (n=18) and MPP group(n=18).Sixteen cases with bronchial foreign body were selected as the control group.The levels of IL-6,MCP-1,IFN-γ and T-cell subset in BALF were detected by ELISA and alkaline phosphatase-anti-alkaline phosphatase(APAAP) bridging enzyme linked immunosorbent assay.Results (1)The levels of CD3 +and CD8 +T cells in BALF of MPP group and RMPP group were higher than those in the control group(P<0.05),but there were no significant differences between the two groups (P>0.05).(2) The level of IL-6 in acute phase of RMPP group was higher than that in the control group(P<0.05).The levels of IL-6 in acute phase of RMPP group and MPP group were both higher than that in recovery period(P<0.05,respectively).(3)The levels of IFN-γ in the acute phase of RMPP group and MPP group were higher than that in the control group,and the differences were statistically significant(P<0.05).The IFN-γ levels in acute and recovery phases of RMPP group were both significantly higher than those in MPP group respectively(P< 0.05).(4)The level of MCP-1 in BALF in control group was lower than those in the acute phase of RMPP group and MPP group(P<0.05).The level of MCP-1 in RMPP acute group was significantly higher than that in MPP acute group,and higher in acute phase than those in recovery phase both in two groups(P<0.05).Conclusion There are cell immune regulation and function disorders when children are infected mycoplasma pneumoniae. IL-6, IFN-γ and MCP-1 may participate in the pathogenesis of MPP,and more importantly,IFN-γ and MCP-1 may be the important indicator to forecast the severity of MPP.