血清TIMＧ4、HBD2表达水平与肺炎支原体肺炎儿童病情的相关性研究

The correlation between the expression levels of serum TIMＧ4 and HBD2 and the condition of children with Mycoplasma pneumoniae pneumonia

摘要

目的 探讨血清T细胞免疫球蛋白与黏蛋白域分子Ｇ4(TIMＧ4)和人βＧ防御素2(HBD2)表达水平与肺炎支原体肺炎(MPP)儿童病情的相关性。方法 选取本院于2020年7月至2023年1月收治的142例MPP患儿为研究对象,根据病情严重程度分为普通MPP组(n=99)和难治性MPP组(n=43),另选取同期140例健康体检儿童为对照组。使用酶联免疫吸附试验(ELISA)检测血清TIMＧ4和HBD2水平;收集患儿临床资料,并采用多因素Logistic回归分析发生难治性MPP的影响因素;使用受试者工作特征(ROC)曲线分析血清TIMＧ4和HBD2水平对难治性MPP的诊断价值。结果 普通MPP组和难治性MPP组在发热时间、住院时间、阿奇霉素治疗时间、中性粒细胞百分比、白细胞计数、反复呼吸道感染、肺外并发症方面比较差异具有统计学意义(t/χ²值介于2.195~21.265,P<0.05);与对照组相比,研究组血清TIMＧ4和HBD2表达水平均明显升高(t=34.527、40.646,P<0.001);与普通MPP组相比,难治性MPP组血清TIMＧ4和HBD2表达水平均明显升高(t=12.410、15.316,P<0.001);多因素Logistic回归分析结果显示,血清TIMＧ4水平(OR=1.423,95%CI:1.140~1.776)、HBD2水平(OR=1.436,95%CI:1.162~1.775)、发热时间(OR=1.349,95%CI:1.056~1.724)、中性粒细胞百分比(OR=1.334,95%CI:1.032~1.725)、反复呼吸道感染(OR=1.521,95%CI:1.245~1.858)和肺外并发症(OR=1.432,95%CI:1.152~1.780)均是发生难治性MPP的独立危险因素(P<0.05)。ROC结果显示,血清TIMＧ4水平单独诊断难治性MPP发生的曲线下面积(AUC)为0.845(95%CI:0.774~0.900),灵敏度、特异度分别为69.77%、85.86%;血清HBD2水平单独诊断难治性MPP发生的AUC为0.815(95%CI:0.742~0.875),灵敏度、特异度分别为74.42%、82.83%;二者联合诊断难治性MPP发生的AUC为0.908(95%CI:0.848~0.950),灵敏度、特异度分别为90.70%、81.82%,显著高于血清TIMＧ4水平单独诊断(Z=2.047,P=0.040)和血清HBD2水平单独诊断(Z=2.443,P=0.015)。结论 血清TIMＧ4及HBD2水平在肺炎支原体肺炎儿童中表达升高,且二者水平对难治性肺炎支原体肺炎具有一定诊断价值。

Abstract

Objective To explore the correlation between the expression levels of serum T cell immunoglobulin and mucin domain moleculeＧ4 (TIMＧ4) and human βＧdefensin2 (HBD2) and the disease of children with Mycoplasma pneumoniae pneumonia (MPP). Methods A total of 142 children with MPP admitted to our hospital from July 2020 to January 2023 were collected as the study subjects, and according to the severity of their diseases, they were divided into the ordinary MPP group (n=99) and the refractory MPP group (n=43), and 140 children with healthy physical examination during the same period were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum TIMＧ4 and HBD2 levels; the clinical data of pediatric patients were collected, and the influencing factors of refractory MPP were analyzed by multivariate logistic regression analysis; receiver operating characteristic (ROC) curves were applied to analyze the diagnostic value of serum TIMＧ4 and HBD2 levels in refractory MPP. Results There were statistically significant differences between the ordinary MPP group and the refractory MPP group in terms of fever duration, hospital stay, azithromycin treatment time, neutrophil percentage, white blood cell count, recurrent respiratory tract infections, and extrapulmonary complications (t/χ² value ranged from 2.195-21.265, P<0.05); compared with the control group, the expression levels of serum TIMＧ4 and HBD2 in the study group were significantly higher (t=34.527 and 40.646, respectively, P<0.05); compared with the ordinary MPP group, the expression levels of serum TIMＧ4 and HBD2 in the refractory MPP group were significantly higher (t=12.410 and 15.316, respectively, P<0.001). The results of multivariate logistic regression analysis showed that serum TIMＧ4 level (OR=1.423, 95%CI: 1.140-1.776), HBD2 level (OR=1.436, 95%CI: 1.162-1.775), fever duration (OR=1.349, 95%CI: 1.056-1.724), neutrophil percentage (OR=1.334, 95%CI: 1.032-1.725), recurrent respiratory infections (OR=1.521, 95%CI: 1.245-1.858), and extrapulmonary complications (OR=1.432, 95%CI: 1.152-1.780) were all independent risk factors for the development of refractory MPP (P<0.05). The ROC results showed that the area under the curve (AUC) of serum TIMＧ4 level in the diagnosis of refractory MPP alone was 0.845 (95%CI: 0.774-0.900), and the sensitivity and specificity were 69.77% and 85.86%, respectively; the AUC of serum HBD2 level alone in the diagnosis of refractory MPP was 0.815 (95%CI: 0.742-0.875), and the sensitivity and specificity were 74.42% and 82.83%, respectively; the AUC of refractory MPP diagnosed by the combination of the two was 0.908 (95%CI: 0.848-0.950), and the sensitivity and specificity were 90.70% and 81.82%, respectively, which was significantly higher than those of serum TIMＧ4 level alone (Z=2.047, P=0.040) and serum HBD2 level alone (Z=2.443, P=0.015). Conclusion The expression of serum TIMＧ4 and HBD2 is increased in children with Mycoplasma pneumoniae pneumonia, and their levels are elevated in the diagnosis of refractory Mycoplasma pneumoniae pneumonia.

关键词

肺炎支原体肺炎 / T细胞免疫球蛋白与黏蛋白域分子Ｇ4 / 重组人βＧ防御素2

Key words

Mycoplasma pneumoniae pneumonia / T cell immunoglobulin and mucin domain moleculeＧ4 / recombinant human βＧdefensin2

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