MPP患儿血浆sB7-H3水平与疾病严重程度及临床和影像学特征的关系-东南大学学报医学版

MPP患儿血浆sB7-H3水平与疾病严重程度及临床和影像学特征的关系

单位：界首市人民医院儿科, 安徽界首 236500

关键词：肺炎支原体肺炎可溶性B7-H3 疾病严重程度临床特征胸部X线检查结果儿童

分类号：R563.1; R725.6

出版年·卷·期（页码）：2023·42·第三期（369-376）

摘要：

目的: 分析肺炎支原体肺炎(MPP)患儿血浆可溶性B7-H3(sB7-H3)水平与疾病严重程度及临床和影像学特征的关系。方法: 收集2018年1月至2022年6月在我院诊断为MPP的14岁以下住院儿童共382例,采集入院后24 h内的外周血样本。同时选择200例在我院接受择期手术的无任何感染证据的儿童作为对照组。采用酶联免疫吸附试验法检测血浆sB7-H3和细胞炎症因子水平。分析MPP患儿的临床特征和胸片影像学表现。结果: 与对照组相比,MPP患儿基线血浆sB7-H3水平显著升高(P＜0.001),且重度MPP患儿基线血浆sB7-H3水平显著高于轻度MPP患儿(P＜0.001)。血浆sB7-H3高水平亚组患儿咳痰、低氧血症、心动过速、肺部湿啰音、肺外表现、胸腔积液等临床症状和体征更常见,且白细胞计数、血小板计数、C反应蛋白水平更高(P＜0.05)。经多因素Logistic回归分析,基线血浆sB7-H3水平升高是重度MPP的独立危险因素(P＜0.05)。经受试者工作特征曲线分析,基线血浆sB7-H3(AUC:0.855)水平对于区分轻度MPP和重度MPP患儿有良好的价值。此外,经Spearman相关性分析,MPP患儿基线血浆sB7-H3水平与发热持续时长,抗生素使用时长,住院时长,炎症细胞因子γ-干扰素、白细胞介素-17、粒细胞-巨噬细胞集落刺激因子均呈正相关(P＜0.001)。实变亚组患儿基线血浆sB7-H3水平显著高于非实变亚组(P＜0.001)。结论: MPP患儿基线血浆sB7-H3水平普遍升高,高sB7-H3水平预示着机体炎症反应更严重,肺叶或节段性实变可能性更高,sB7-H3可作为区分重度MPP和轻度MPP的有价值的生物标志物。

Objective: To analyze the relationship between serum soluble B7-H3(sB7-H3) and disease severity, clinical and imaging characteristics in children with Mycoplasma pneumoniae pneumonia(MPP). Methods: A total of 382 hospitalized children under 14 years old diagnosed with MPP in our hospital from January 2018 to June 2022 were collected, and peripheral blood samples were collected within 24 hours after admission. At the same time, 200 children who received elective surgery in our hospital without any evidence of infection were selected as the control group. Plasma of sB7-H3 level and inflammatory cytokines were detected by enzyme linked immunosorbent assay. The clinical features and chest radiographic findings of children with MPP were analyzed. Results: Compared with the control group, the baseline plasma sB7-H3 level in children with MPP was significantly increased(P＜0.001), and the baseline plasma sB7-H3 level in children with severe MPP was significantly higher than that in children with mild MPP(P＜0.001). Sputum, hypoxemia, tachycardia, pulmonary rurgis, extrapulmonary manifestations, pleural effusion and other clinical symptoms were more common in the subgroup with high level of sB7-H3, and the levels of white blood cell count, platelet count and C-reactive protein were higher(P＜0.05). Multivariate Logistic regression analysis showed that elevated baseline plasma sB7-H3 level was an independent risk factor for severe MPP(P＜0.05). According the receiver operating characteristic, baseline plasma sB7-H3(AUC: 0.855) was of good value in differentiating mild MPP from severe MPP. In addition, Spearman correlation analysis showed that the baseline plasma sB7-H3 level of MPP children were positively correlated with the duration of fever, duration of antibiotic use, length of hospital stay, inflammatory cytokine γ-interferon, interleukin-17 and granulocytemacrophage colony-stimulating factors(P＜0.001). The baseline plasma sB7-H3 level in the consolidation subgroup was significantly higher than that in the non-consolidation subgroup(P＜0.001). Conclusion: The baseline plasma sB7-H3 level is generally elevated in children with MPP. High sB7-H3 level indicates a more serious inflammatory response and a higher possibility of pulmonary lobe or segmental consolidation. sB7-H3 can be used as a valuable biomarker to distinguish severe MPP and mild MPP.

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