血清蛋白成分及炎性细胞因子与支原体肺炎患儿病情严重程度的相关性研究
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摘要
目的检测支原体肺炎患儿血清白蛋白、α1、α2、β、γ球蛋白及κ、λ轻链、炎性细胞因子的水平,探讨其临床意义。方法选择2014年1月-2016年1月湖北省妇幼保健院儿科确诊的224例肺炎支原体肺炎(MPP)患儿,包括普通MPP患儿组163例,重症MPP组61例,同期健康体检儿童50例作为对照组。测定对照组和MPP组急性期及恢复期的血清蛋白成分比例变化及κ、λ轻链、IL-2、IL-6、IL-8、TNF-α水平。结果急性期,普通MPP组和重症MPP组的血白蛋白(albumin,ALB)比例均较对照组显著下降,α1、α2、γ球蛋白比例显著升高(P<0.05),以重症MPP组变化更加明显(P<0.05)。恢复期,普通MPP组和重症MPP组的ALB比例均较急性期升高,α1、α2、γ球蛋白比例均较急性期下降(P<0.05)。普通MPP组和重症MPP组的β球蛋白比例变化差异均无统计学意义(P>0.05)。急性期普通MPP组和重症MPP组的血IgG、IgA、IgM水平较对照组均显著升高(P<0.05),重症MPP组升高更加明显(P<0.05),恢复期IgG、IgA、IgM水平较急性期显著下降(P<0.05)。各组的κ轻链、λ轻链变化差异无统计学意义(P>0.05)。普通MPP组和重症MPP组在急性期血IL-2水平较对照组降低,hs-CRP、IL-6、IL-8、TNF-α较对照组升高,且以重症MPP组变化更加明显(P<0.05)。至恢复期,普通MPP组和重症MPP组的IL-2水平均较急性期升高,hs-CRP、IL-6、IL-8、TNF-α水平较急性期降低(P<0.05)。结论炎症因子参与了MPP的发生发展,血清蛋白电泳各成分比例的变化程度与MPP的病情轻重存在相关性,通过动态监测血清蛋白电泳各成分比例变化,可为MPP提供临床评估依据。
Objective To detect the levels of serum albumin, α1, α2, β and γ globulins, κ and λ light chains and inflammatory cytokines in children with mycoplasma pneumonia, and to explore their clinical values. Methods Two hundred and twenty-four children diagnosed with Mycoplasma pneumoniae pneumonia(MPP) in Department of Paediatrics, Hubei Provincial Maternal and Child Health Care Hospital from January 2014 to January 2016 were selected to divide into the common MPP group(n=163) and the severe MPP group(n=61). And 50 children receiving health check-up during the same period served as the control group. The levels of serum protein composition in the acute and recovery stages and the levels of κ and λ light chains, IL-2, IL-6, IL-8 and TNF-α in the control group and the MPP group were measured. Results The albumin(ALB) ratio in the acute stage was significantly lower in the common and severe MPP groups than in the control group, but the ratios of α1, α2 and γ globulins increased significantly(P<0.05), with more significant changes in the severe MPP group(P<0.05). The ALB ratios of the common and severe MPP groups in the recovery stage were higher than those in the acute stage, but the ratios of α1, α2 and γ globulins in the recovery stage were all lower than those in the acute stage(P<0.05). No statistically significant difference was found in the change of ratio of β globulin between the common MPP group and the severe MPP group(P>0.05). The levels of IgG, IgA and IgM in the acute stage were significantly higher in the common and severe MPP groups than in the control group(P<0.05), and those in the severe MPP group increased more significantly(P<0.05). The levels of IgG, IgA and IgM in the recovery stage were significantly lower than those in the acute stage(P<0.05). No statistically significant differences were found in the changes of κ and λ light chains between the common MPP group and the severe MPP group in the acute and recovery stages(P>0.05). The level of IL-2 in the acute stage was lower in the common and severe MPP groups than in the control group( P<0.05),while the levels of hs-CRP,IL-6,IL-8 and TNF-α were significantly higher in the common and severe MPP groups than in the control group( P < 0. 05),with more significant changes in the severe MPP group( P < 0. 05). In the common and severe MPP groups,the level of IL-2 was higher in the recovery stage than in the acute stage( P<0.05),while the levels of hs-CRP,IL-6,IL-8 and TNF-α in the recovery stage were all lower than those in the acute phase( P< 0.05). Conclusions Inflammatory factors are involved in the occurrence and development of MPP. There is a correlation between the ratio of each composition of serum protein electrophoresis and the severity of MPP. Dynamical monitoring of the ratio of each composition of serum protein electrophoresis can provide a clinical evaluation basis for MPP.
Objective To detect the levels of serum albumin, α1, α2, β and γ globulins, κ and λ light chains and inflammatory cytokines in children with mycoplasma pneumonia, and to explore their clinical values. Methods Two hundred and twenty-four children diagnosed with Mycoplasma pneumoniae pneumonia(MPP) in Department of Paediatrics, Hubei Provincial Maternal and Child Health Care Hospital from January 2014 to January 2016 were selected to divide into the common MPP group(n=163) and the severe MPP group(n=61). And 50 children receiving health check-up during the same period served as the control group. The levels of serum protein composition in the acute and recovery stages and the levels of κ and λ light chains, IL-2, IL-6, IL-8 and TNF-α in the control group and the MPP group were measured. Results The albumin(ALB) ratio in the acute stage was significantly lower in the common and severe MPP groups than in the control group, but the ratios of α1, α2 and γ globulins increased significantly(P<0.05), with more significant changes in the severe MPP group(P<0.05). The ALB ratios of the common and severe MPP groups in the recovery stage were higher than those in the acute stage, but the ratios of α1, α2 and γ globulins in the recovery stage were all lower than those in the acute stage(P<0.05). No statistically significant difference was found in the change of ratio of β globulin between the common MPP group and the severe MPP group(P>0.05). The levels of IgG, IgA and IgM in the acute stage were significantly higher in the common and severe MPP groups than in the control group(P<0.05), and those in the severe MPP group increased more significantly(P<0.05). The levels of IgG, IgA and IgM in the recovery stage were significantly lower than those in the acute stage(P<0.05). No statistically significant differences were found in the changes of κ and λ light chains between the common MPP group and the severe MPP group in the acute and recovery stages(P>0.05). The level of IL-2 in the acute stage was lower in the common and severe MPP groups than in the control group( P<0.05),while the levels of hs-CRP,IL-6,IL-8 and TNF-α were significantly higher in the common and severe MPP groups than in the control group( P < 0. 05),with more significant changes in the severe MPP group( P < 0. 05). In the common and severe MPP groups,the level of IL-2 was higher in the recovery stage than in the acute stage( P<0.05),while the levels of hs-CRP,IL-6,IL-8 and TNF-α in the recovery stage were all lower than those in the acute phase( P< 0.05). Conclusions Inflammatory factors are involved in the occurrence and development of MPP. There is a correlation between the ratio of each composition of serum protein electrophoresis and the severity of MPP. Dynamical monitoring of the ratio of each composition of serum protein electrophoresis can provide a clinical evaluation basis for MPP.
引文
[1]陈霞,刘文恩,蒋红梅,等.1 691例呼吸道感染患者病原学流行病学调查[J].实用预防医学,2018,25(8):975-977.
[2]梅淑芬,金海丽,王孙尧.儿童难治性肺炎支原体肺炎临床特点分析[J].中国中西医结合急救杂志,2017,24(2):129-132.
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[8]戚应杰,刘忠,刁联硕.慢性丙型肝炎患者血清球蛋白水平与病毒载量的相关性研究[J].实用肝脏病杂志,2012,15(4):354-355.
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[10]邓会英,高岩.血清蛋白电泳与尿蛋白电泳在儿科肾脏疾病中的联合应用[J].中国中西医结合肾病杂志,2007,8(3):156-157.
[11]林宗泽,吴亮.红霉素序贯疗法对支原体肺炎患儿免疫球蛋白、细胞因子水平的影响研究[J].中国全科医学,2017,20(7):118-120.
[12]杨香红,李艳莉,罗春玉.肺炎支原体肺炎患儿免疫功能的变化及其与病情程度和疾病分期的关系[J].实用临床医药杂志,2016,20(1):113-116.
[13]王全,蒋健飞,赵德育.肺炎支原体肺炎发生肺外并发症的危险因素[J].中华实用儿科临床杂志,2013,28(10):749-751.
[14]陈晓颖,董汉权,郭伟,等.417例肺炎支原体肺炎肺外并发症临床分析[J].天津医药,2013,55(7):668-670.
[15]李艳红,陈永森.不同肺炎支原体感染病期婴幼儿免疫功能及炎症因子的动态变化[J].海南医学院学报,2017,23(2):240-243.
[16]刘芳,赵宇华,陈霜慧.IL-6、IL-8及IL-10在肺炎支原体肺炎患儿血清中的表达及临床意义[J].实用临床医药杂志,2015,19(1):61-63,66.
[17]聂红国.小儿肺炎支原体肺炎的临床分析[D].乌鲁木齐:新疆医科大学,2012.
[2]梅淑芬,金海丽,王孙尧.儿童难治性肺炎支原体肺炎临床特点分析[J].中国中西医结合急救杂志,2017,24(2):129-132.
[3]周朋,周旭,张葆青.儿童难治性支原体肺炎发病机制研究进展[J].山东医药,2016,56(1):103-105.
[4]编辑委员会.儿童肺炎支原体肺炎诊治专家共识[J].中华实用儿科临床杂志,2015,30(17):1304-1308.
[5]赵丽燕.婴幼儿肺炎支原体肺炎急性期与恢复期免疫功能及炎症因子变化[J].中国妇幼保健,2014,29(1):86-88.
[6]陈玮,邓中华,刘俊.小儿肺炎支原体肺炎患儿支气管肺泡灌洗液IL-6、IL-10表达情况研究[J].实用预防医学,2015,22(3):303-304.
[7]陈波,张经.支原体肺炎患儿血清体液免疫检测的临床研究[J].临床肺科杂志,2012,17(6):1045-1046.
[8]戚应杰,刘忠,刁联硕.慢性丙型肝炎患者血清球蛋白水平与病毒载量的相关性研究[J].实用肝脏病杂志,2012,15(4):354-355.
[9]王金行,周立平,阎莉莉,等.血清蛋白电泳在类风湿性关节炎诊治中的应用[J].中国医科大学学报,2011,40(8):729-731.
[10]邓会英,高岩.血清蛋白电泳与尿蛋白电泳在儿科肾脏疾病中的联合应用[J].中国中西医结合肾病杂志,2007,8(3):156-157.
[11]林宗泽,吴亮.红霉素序贯疗法对支原体肺炎患儿免疫球蛋白、细胞因子水平的影响研究[J].中国全科医学,2017,20(7):118-120.
[12]杨香红,李艳莉,罗春玉.肺炎支原体肺炎患儿免疫功能的变化及其与病情程度和疾病分期的关系[J].实用临床医药杂志,2016,20(1):113-116.
[13]王全,蒋健飞,赵德育.肺炎支原体肺炎发生肺外并发症的危险因素[J].中华实用儿科临床杂志,2013,28(10):749-751.
[14]陈晓颖,董汉权,郭伟,等.417例肺炎支原体肺炎肺外并发症临床分析[J].天津医药,2013,55(7):668-670.
[15]李艳红,陈永森.不同肺炎支原体感染病期婴幼儿免疫功能及炎症因子的动态变化[J].海南医学院学报,2017,23(2):240-243.
[16]刘芳,赵宇华,陈霜慧.IL-6、IL-8及IL-10在肺炎支原体肺炎患儿血清中的表达及临床意义[J].实用临床医药杂志,2015,19(1):61-63,66.
[17]聂红国.小儿肺炎支原体肺炎的临床分析[D].乌鲁木齐:新疆医科大学,2012.