| 摘要: |
| ［摘要］ 目的 分析支气管肺泡灌洗液（BALF）中细胞分类及炎症因子水平与肺炎支原体肺炎(MPP)合并气道黏液栓患儿预后的关联性。方法 选择2018年2月至2022年2月于佳木斯中心医院接受支气管肺泡灌洗术的168例MPP患儿的临床资料，根据支气管镜下查出气道黏液栓存在情况，将其分为MPP合并气道黏液栓组（78例）和单纯MPP组（90例）。根据病程2个月时影像学复查结果，将MPP合并气道黏液栓组患儿分为肺炎吸收缓慢组（35例）和肺炎完全吸收组（43例）。应用瑞氏-吉姆萨染色法测定BALF中各细胞分类水平。应用酶联免疫吸附试验检测BALF中白介素（IL）-2、IL-4、IL-8、IL-10水平。采用多因素logistic回归分析MPP合并气道黏液栓患儿肺炎吸收缓慢的影响因素。通过受试者工作特征(ROC)曲线分析各指标对MPP合并气道黏液栓患儿预后的预测价值。结果 MPP合并气道黏液栓组BALF巨噬细胞百分比、IL-4、IL-10水平低于单纯MPP组，BALF中性粒细胞百分比、IL-2、IL-8水平高于单纯MPP组，差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示，较长的发热时间、较高的BALF中性粒细胞百分比是促进MPP合并气道黏液栓患儿肺炎吸收缓慢的独立危险因素（P<0.05）；较高的BALF巨噬细胞百分比是抑制肺炎吸收缓慢的保护因素（P<0.05）。ROC曲线分析结果显示，联合发热时间、BALF巨噬细胞百分比、BALF中性粒细胞百分比可有效预测MPP合并气道黏液栓患儿肺炎吸收缓慢的发生情况（P<0.05），其灵敏度和特异度分别为89.00%、75.00%。结论 联合发热时间、BALF巨噬细胞百分比、BALF中性粒细胞百分比可有效预测MPP合并气道黏液栓患儿的预后，指导临床治疗。 |
| 关键词: 肺炎支原体肺炎 黏液栓 支气管肺泡灌洗液 炎症因子 预后 儿童 |
| DOI：10.3969/j.issn.1674-3806.2023.10.16 |
| 分类号:R 725.6 |
| 基金项目:黑龙江省医药卫生科研课题（编号：2020-572） |
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| Analysis on the correlation of cell classification and inflammatory factor levels in bronchoalveolar lavage fluid with the prognosis of pediatric patients suffering from MPP complicated with airway mucus plugs |
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YANG Li-wei, QIU You-xi, YANG Song
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Department of Pediatrics, Jiamusi Central Hospital, Heilongjiang 154000,China
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| Abstract: |
| ［Abstract］ Objective To analyze the correlation of cell classification and inflammatory factor levels in bronchoalveolar lavage fluid(BALF) with the prognosis of pediatric patients suffering from Mycoplasma pneumoniae pneumonia(MPP) complicated with airway mucus plugs. Methods The clinical data of 168 pediatric patients with MPP who received bronchoalveolar lavage in Jiamusi Central Hospital from February 2018 to February 2022 were selected. According to whether the presence of airway mucus plugs was detected under bronchoscopy, the pediatric patients were divided into MPP complicated with airway mucus plug group(78 cases) and simple MPP group(90 cases). According to the results of imaging reexamination after 2 months of disease course, the patients in the MPP complicated with airway mucus plug group were divided into slowly resolving pneumonia group(35 cases) and completely resolving pneumonia group(43 cases). The level of cell classification in BALF was determined by Rayleigh Giemsa staining method. Enzyme-linked immunosorbent assay was used to detect the levels of interleukin(IL)-2, IL-4, IL-8, and IL-10 in BALF. Multivariate logistic regression was used to analyze the influencing factors of slowly resolving pneumonia in the pediatric patients suffering from MPP complicated with airway mucus plugs. Receiver operating characteristic(ROC) curve was used to analyze the predictive value of each index for the pediatric patients suffering from MPP complicated with airway mucus plugs. Results The percentage of macrophages, IL-4 and IL-10 levels in BALF in the MPP complicated with airway mucus plug group were lower than those in the simple MPP group, while the percentage of neutrophils, IL-2 and IL-8 levels in BALF in the MPP complicated with airway mucus plug group were higher than those in the simple MPP group, and the differences were significant(P<0.05). The results of multivariate logistic regression analysis showed that longer duration of fever and higher percentage of neutrophils in BALF were independent risk factors for slowly resolving pneumonia in the pediatric patients suffering from MPP complicated with airway mucus plugs(P<0.05), and higher percentage of macrophages in BALF was a protective factor against slowly resolving pneumonia(P<0.05). The results of ROC curve analysis showed that the combination of the duration of fever, percentage of macrophages in BALF and percentage of neutrophils in BALF could effectively predict the occurrence of slowly resolving pneumonia in the pediatric patients suffering from MPP complicated with airway mucus plugs(P<0.05), and the sensitivity and specificity were 89.00% and 75.00%, respectively. Conclusion The combination of the duration of fever, percentage of macrophages in BALF and percentage of neutrophils in BALF can effectively predict the prognosis of the pediatric patients suffering from MPP complicated with airway mucus plugs and guide clinical treatments for them. |
Key words: Mycoplasma pneumoniae pneumonia(MPP) Mucus plug Bronchoalveolar lavage fluid(BALF)
Inflammatory factor Prognosis Children |
