2017 年第 10 期 第 12 卷

难治性肺炎支原体肺炎患儿的早期临床特征及相关细胞因子水平变化

Early clinical features and changes of cytokines in children with refractory mycoplasma pneumoniae pneumonia

作者：郑茂陈瑶符佳

英文作者：Zheng Mao Chen Yao Fu Jia

单位：710003西安市儿童医院呼吸一科（郑茂），呼吸二科（陈瑶），感染二科（符佳）

英文单位：The First Department of Respiratory Medicine Xi′an Children′s Hospital Xi′an 710003 China（Zheng M）; the Second Department of Respiratory Medicine Xi′an Children′s Hospital Xi′an 710003 China（Chen Y）; the Second Department of Infectious Diseases Xi′an Children′s Hospital Xi′an 710003 China（Fu J）

关键词：支原体，肺炎；难治性；细胞因子

英文关键词：Mycoplasmapneumoniae；Refractory；Cytokines

• 摘要：

• 目的 探讨难治性肺炎支原体肺炎（RMPP）患儿的早期临床特征及相关细胞因子水平的变化。方法 回顾性选取2013年12月至2016年12月西安市儿童医院确诊治疗的RMPP患儿50例作为RMPP组，选取同期普通型肺炎支原体肺炎（GMPP）患儿50例作为GMPP组，所有患儿均行胸部X线片和/或CT检查、纤维支气管镜检查和肺泡灌洗等。比较2组临床特征、胸部X线片和/或CT特征、支气管镜特征和肺泡灌洗液（BALF）中白细胞介素6（IL-6）、IL-10和γ-干扰素水平。结果 2组发热、咳嗽、白细胞计数升高、C反应蛋白升高等临床特征，肺突变、大叶性肺炎、肺门淋巴结肿大、胸腔积液、肺不张等胸部X线片和/或CT特征及气道黏膜充血肿胀、纵行皱褶、分泌物增多、支气管开口炎性狭窄、管腔软化等支气管镜特征比例比较，差异均无统计学意义（均P＞0.05），但RMPP组管腔肉芽组织增生、气道黏液栓堵塞、黏膜糜烂等支气管镜特征检出率和BALF中IL-6和γ-干扰素水平明显高于GMPP组［16.0%(8/50)比4.0%(2/50)、52.0%(26/50)比26.0%(13/50)、16.0%(8/50)比4.0%(2/50)、（32±5）ng/L比（17±3）ng/L、（11.7±2.1）ng/L比（8.0±1.6）ng/L］，BALF中IL-10水平明显低于GMPP组［（4.5±1.0）ng/L比（7.6±1.2）ng/L］，差异均有统计学意义（均P＜0.05）。结论 RMPP与GMPP患儿部分支气管镜特征和BALF中IL-6、IL-10、γ-干扰素等细胞因子水平存在明显差异，提示早期检测临床特征及细胞因子水平变化有利于预测RMPP的发生。

• Objective To investigate early clinical features and changes of cytokines in children with refractory mycoplasma pneumoniae pneumonia（RMPP）. Methods Clinical data of 50 children with RMPP and 50 children with general mycoplasma pneumoniae pneumonia（GMPP）who were admitted in Xi′an Children′s Hospital from December 2013 to December 2016 were retrospectively analyzed. All children had chest X-ray and/or CT scanning, fiberoptic bronchoscopy and bronchoalveolar lavage. Clinical features, X-ray and/or CT findings, bronchoscopic results and levels of interleukin-6（IL-6）, IL-10 and interferon-γ（IFN-γ） in bronchoalveolar lavage fluid（BALF） were analyzed. Results Clinical features（fever, cough, increases of leucocyte count and C-reactive protein）, image features（pulmonary consolidation, lobar pneumonia, hilar lymph node enlargement, pleural effusion and atelectasis） and bronchoscopic features（airway mucosal hyperemia and swelling, longitudinal folds, secretion, bronchial stenosis and luminal softening） showed no significant differences between RMPP group and GMPP group（P＞0.05）. Ratios of luminal granulation tissue hyperplasia, airway obstruction by mucus plugs and mucosal erosion observed by bronchoscopy and levels of IL-6 and IFN-γ in BALF in RMPP group were significantly higher than those in GMPP group［16.0%（8/50） vs 4.0%（2/50）, 52.0%（26/50） vs 26.0%（13/50）, 16.0%（8/50） vs 4.0%（2/50）, （32±5）ng/L vs （17±3）ng/L, （11.7±2.1）ng/L vs （8.0±1.6）ng/L］（P＜0.05）; the level of IL-10 in BALF in RMPP group was significantly lower than that in GMPP group［（4.5±1.0）ng/L vs （7.6±1.2）ng/L］（P＜0.05）. Conclusion There are significant differences of bronchoscopic features and levels of inflammatory cytokines in BALF between children with RMPP and GMPP; early detection of bronchoscopy and cytokines may contribute to predicting the occurrence of RMPP.