| 摘要: |
| ［摘要］ 目的 探讨支气管肺泡灌洗液（BALF）及血清白细胞介素-17A（IL-17A）、细胞间黏附分子-1（ICAM-1）、黏蛋白5AC（MUC5AC）水平与肺炎支原体肺炎（MPP）患儿合并气道黏液栓（AMP）及临床预后的关联性。方法 以1∶2配对设计招募2020年10月至2024年10月长沙市第四医院收治的MPP患儿249例，根据AMP发生情况分为AMP组（83例）和非AMP组（166例）。于治疗前采集BALF和血清标本，通过酶联免疫吸附试验检测其IL-17A、ICAM-1、MUC5AC水平，并进行组间比较。随访观察患儿入院治疗28 d后的预后情况。通过logistic回归分析影响MPP合并AMP患儿预后的因素，通过受试者工作特征（ROC）曲线分析BALF及血清IL-17A、ICAM-1、MUC5AC水平诊断MPP患儿合并AMP的效能以及预测MPP合并AMP患儿预后的效能。结果 AMP组BALF及血清IL-17A、ICAM-1、MUC5AC水平均高于非AMP组，差异有统计学意义（P<0.05）。ROC曲线分析结果显示，BALF及血清IL-17A、ICAM-1、MUC5AC水平均可有效诊断MPP患儿合并AMP（P<0.05），且三指标联合诊断效能优于单一指标（P<0.05），BALF三指标联合诊断效能与血清三指标联合诊断相当，差异无统计学意义（Z=1.303，P=0.193）。MPP合并AMP患儿预后不良率为36.14%（30/83）。多因素logistic回归分析结果显示，BALF及血清较高的IL-17A、ICAM-1、MUC5AC水平是MPP合并AMP患儿预后不良的独立危险因素（P<0.05）。ROC曲线分析结果显示，BALF及血清IL-17A、ICAM-1、MUC5AC水平均可有效预测MPP合并AMP患儿预后不良（P<0.05），且三指标联合的预测效能优于单一指标（P<0.05），BALF三指标联合预测效能与血清三指标联合预测相当，差异无统计学意义（Z=1.426，P=0.141）。结论 BALF及血清IL-17A、ICAM-1、MUC5AC水平升高与MPP患儿合并AMP及临床预后不良相关，三指标联合检测有助于临床医师及早识别高危患儿并予以积极干预治疗，改善其预后。 |
| 关键词: 肺炎支原体肺炎 白细胞介素-17A 细胞间黏附分子-1 黏蛋白5AC 气道黏液栓 临床预后 |
| DOI：10.3969/j.issn.1674-3806.2025.12.10 |
| 分类号:R 725.6 |
| 基金项目:湖南省自然科学基金项目（编号：2022JJ40332） |
|
| Analysis on associations of IL-17A, ICAM-1 and MUC5AC levels in bronchoalveolar lavage fluid and serum with MPP complicating AMP and clinical prognosis in pediatric patients |
|
LI Fang1, ZOU Deng1, LEI Chaolan1, PENG Xinxin2, LEI Yuan1
|
|
1.Department of Pediatrics, the Fourth Hospital of Changsha(Changsha Integrated Traditional Chinese and Western Medicine Hospital), Changsha 410006, China; 2.Children′s Medical Center, the First Hospital of Hunan University of Chinese Medicine, Changsha 410020, China
|
| Abstract: |
| ［Abstract］ Objective To explore the associations of interleukin-17A(IL-17A), intercellular adhesion molecule-1(ICAM-1) and mucin 5AC(MUC5AC) levels in bronchoalveolar lavage fluid(BALF) and serum with Mycoplasma pneumoniae pneumonia(MPP) complicating airway mucus plugs(AMP) and clinical prognosis in pediatric patients. Methods A total of 249 pediatric patients with MPP who were admitted to the Fourth Hospital of Changsha from October 2020 to October 2024 were recruited in a 1∶2 matching design. The pediatric patients were divided into AMP group(83 patients) and non-AMP group(166 patients) according to the occurrence of AMP. BALF and serum specimens were collected before treatment. The levels of IL-17A, ICAM-1 and MUC5AC in BALF and serum were detected by using enzyme-linked immunosorbent assay(ELISA) and were compared between the two groups. The pediatric patients were followed up and their prognosis was observed 28 days after admission for treatment. The factors influencing prognosis of the MPP pediatric patients complicated with AMP were analyzed by using logistic regression. The efficacy of IL-17A, ICAM-1 and MUC5AC levels in BALF and serum in diagnosing the MPP pediatric patients complicated with AMP and the efficacy in predicting the prognosis of the MPP pediatric patients complicated with AMP were analyzed by using receiver operating characteristic(ROC) curve. Results The levels of IL-17A, ICAM-1 and MUC5AC in BALF and serum in the AMP group were higher than those in the non-AMP group, with statistically significant differences between the two groups(P<0.05). The results of ROC curve analysis showed that the levels of IL-17A, ICAM-1 and MUC5AC in BALF and serum could effectively diagnose the MPP pediatric patients complicated with AMP(P<0.05), and the diagnostic efficacy of the combination of the three indicators was superior to that of a single indicator(P<0.05), and the combined diagnostic efficacy of the three indicators in BALF was comparable to that of the three indicators in serum, and the difference was not statistically significant(Z=1.303, P=0.193). The poor prognosis rate of the MPP pediatric patients complicated with AMP was 36.14%(30/83). The results of multivariate logistic regression analysis showed that higher levels of IL-17A, ICAM-1 and MUC5AC in BALF and serum were independent risk factors for poor prognosis in the MPP pediatric patients complicated with AMP(P<0.05). The results of ROC curve analysis showed that the levels of IL-17A, ICAM-1 and MUC5AC in BALF and serum could effectively predict the poor prognosis of the MPP pediatric patients complicated with AMP(P<0.05), and the diagnostic efficacy of the combination of the three indicators was superior to that of a single indicator(P<0.05). The combined diagnostic efficacy of the three indicators in BALF was comparable to that of the three indicators in serum, and the difference was not statistically significant(Z=1.426, P=0.141). Conclusion Elevated levels of IL-17A, ICAM-1 and MUC5AC in BALF and serum are associated with the complicating AMP and poor clinical prognosis in MPP pediatric patients. The combined detection of the three indicators is helpful for clinicians to identify the high-risk pediatric patients and perform active interventions and treatments, improving the prognosis of the pediatric patients. |
| Key words: Mycoplasma pneumoniae pneumonia(MPP) Interleukin-17A(IL-17A) Intercellular adhesion molecule-1(ICAM-1) Mucin 5AC(MUC5AC) Airway mucus plugs（AMP） Clinical prognosis |
