难治性肺炎支原体肺炎患儿T淋巴细胞亚群和高迁移率族蛋白B1的表达水平及临床意义

目的：探讨难治性肺炎支原体肺炎（RMPP）患儿T淋巴细胞亚群及高迁移率族蛋白B1（HMGB1）的表达情况，为临床早期诊断RMPP提供参考。方法：选择2016-2018年在我院儿科接受治疗的肺炎支原体肺炎（MPP）患儿430例，其中RMPP患儿106例（RMPP组），非RMPP患儿324例（NRMPP组）；另选同期体检健康儿童106例（NC组）作为对照组。分析三组儿童的临床资料及T淋巴细胞亚群、淋巴细胞绝对计数、HMGB1、C反应蛋白（CRP）及降钙素原（PCT）等生化指标的差异性；利用ROC评估RMPP的预测指标。结果：与NRMPP组和NC组相比，RMPP组患儿的CD3+、CD3+CD4+、CD4+/CD8+、CD3-CD19+、CD19+CD23+、CD3-CD（16+56+）绝对值均下降，外周血淋巴细胞绝对计数、HMGB1、CRP及PCT水平均升高（P均<0.05）。ROC分析显示，CD3+CD4+、CD19+CD23+、HMGB1、CRP及PCT水平可预测RMPP，其AUC（95% CI）分别为0.887（0.857，0.917）、0.827（0.788，0.865）、0.907（0.863，0.951）、0.844（0.789，0.898）、0.788（0.727，0.849），敏感性分别为87%、82%、89%、85%、79%，特异性分别为78%、74%、81%、76%、72%。结论：RMPP患儿T淋巴细胞亚群及血清HMGB1水平升高，提示免疫系统的紊乱机制参与了RMPP的发病过程，故T淋巴细胞亚群及血清HMGB1水平可作为RMPP的预测指标。

Expression and Clinical Significance of T Lymphocyte Subsets and High Mobility Group Protein B1 Levels in Children with Refractory Mycoplasma Pneumoniae Pneumonia

Objective: To probe into the the expression of T lymphocyte subsets and high mobility group protein B1 (HMGB1) in patients with refractory Mycoplasma pneumoniae pneumonia (RMPP), so as to provide reference for early clinical diagnosis of RMPP. Methods: Totally 430 children with Mycoplasma pneumonia (MPP) admitted into pediatrics of our hospital from 2016 to 2018 were extracted, including 106 children with RMPP (RMPP group) and 324 children with non-RMPP (NRMPP group). And 106 healthy children (NC group) were selected as the control group during the same period. Differences of clinical data and biochemical indicators such as T lymphocyte subsets, absolute lymphocyte count, HMGB1, C-reactive protein (CRP) and procalcitonin (PCT) of three groups were analyzed. ROC curve was used to evaluate the predictive index of RMPP. Results: Compared with the NRMPP group and the NC group, absolute values of CD3+, CD3+CD4+, CD4+/CD8+, CD3-CD19+, CD19+CD23+ and CD3-CD(16+56+) in the lymphocyte subsets of the RMPP group decreased significantly, the absolute counts of peripheral blood lymphocytes, HMGB1, CRP and PCT levels of the RMPP group increased significantly, with statistically significant differences (P<0.05). ROC curve analysis showed that the levels of CD3+CD4+, CD19+CD23+, HMGB1, CRP and PCT could predict RMPP, and the AUC (95% CI) was respectively 0.887 (0.857, 0.917), 0.827 (0.788, 0.865), 0.907 (0.863, 0.951), 0.844 (0.789, 0.898) and 0.788 (0.749, 0.849), with a sensitivity of 87%, 82%, 89%, 85% and 79% respectively and a specificity of 78%, 74%, 81%, 76% and 72% respectively. Conclusion: Increased levels of T lymphocyte subsets and serum HMGB1 in children with RMPP suggest that immune system disorders are involved in the pathogenesis of RMPP, therefore, T lymphocyte subsets and serum HMGB1 levels can be used as predictors of RMPP.