儿童难治性肺炎支原体肺炎 CD4⁺/CD8⁺ 比值的变化与疾病分期的关系及对塑型性支气管炎的预测

Relationship of change in CD4 ⁺/CD8 ⁺ ratio with disease staging in children with refractory Mycoplasma pneumoniae pneumonia and its prediction for plastic bronchitis

摘要

目的 探究儿童难治性肺炎支原体肺炎(RMPP)CD4⁺/CD8⁺比值的变化与疾病分期的关系及对塑型性支气管炎(PB)的预测。方法 选取2020年1月至2023年12月聊城市第二人民医院华美院区收治的237例儿童支原体肺炎(MPP)确诊患者为研究对象。根据治疗反应情况,分为普通组(144例)和RMPP组(93例),比较两组患者临床资料,分析RMPP发生的影响因素。进一步将RMPP组按是否合并PB分为PB亚组(38例)和非PB亚组(55例),多因素Logistic回归分析RMPP发生的影响因素,广义线性混合模型判断CD4⁺/CD8⁺比值与RMPP并发PB之间的关系,受试者工作特征(ROC)曲线评价CD4⁺/CD8⁺比值对RMPP并发PB的预测价值。结果 与普通组相比,RMPP组热程更久,持续高热＞7天的患儿人数更多,白细胞(WBC)、中性粒细胞百分比(NEUT)、C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)、D-二聚体水平更高,CD3⁺、CD4⁺、CD8⁺和CD4⁺/CD8⁺比值水平更低,差异均具有统计学意义(t/χ²值介于1.999~22.720之间,P＜0.05);多因素Logistic回归结果显示,热程和WBC水平为影响RMPP发生的危险因素,CD4⁺/CD8⁺比值为影响RMPP发生的保护因素(OR值分别为1.962、2.258、0.015,P＜0.05);亚组分析结果显示,CD4⁺/CD8⁺与RMPP并发PB的相关性稳定存在,CD4⁺/CD8⁺越小,RMPP并发PB风险越大;ROC曲线分析结果显示,CD4⁺/CD8⁺比值预测RMPP并发PB的曲线下面积为0.831(95%CI:0.741~0.917),灵敏度为85.25%,特异度为86.32%。结论 CD4⁺/CD8⁺比值与儿童支原体肺炎疾病严重程度具有相关性,CD4⁺/CD8⁺比值为儿童难治性肺炎支原体肺炎发生的保护因素,且CD4⁺/CD8⁺比值越小,儿童难治性肺炎支原体肺炎并发塑型性支气管炎风险越大。

Abstract

Objective To investigate relationship of change in CD4⁺/CD8⁺ ratio with disease severity and its prediction for plastic bronchitis (PB) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods 237 patients with confirmed Mycoplasma pneumoniae pneumonia (MPP) who admitted to Huamei Campus of Liaocheng Second People's Hospital from January 2020 to December 2023 were selected as study subjects. According to treatment response, the patients were divided into common MPP group (144 cases) and RMPP group (93 cases). The clinical data of the patients were compared between the two groups and influencing factors of RMPP were analyzed. The patients in the RMPP group were further divided into PB subgroup (38 cases) and non-PB subgroup (55 cases) according to whether the patient was complicated with PB. Multivariate Logistic regression was used to analyze influencing factors of occurrence of RMPP. The generalized linear mixed model was used to analyze relationship between CD4⁺/CD8⁺ ratio and RMPP complicated with PB. The receiver operating characteristic (ROC) curve was used to evaluate predictive value of CD4⁺/CD8⁺ ratio for RMPP complicated with PB. Results Compared with the common MPP group, the patients in the RMPP group had a longer duration of fever, a larger number of children had persistent high fever for more than 7 days, and they had higher levels of white blood cells (WBC), neutrophil (NEUT), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH) and D-dimer, and their serum levels of CD3⁺, CD4⁺, CD8⁺ and ratio of CD4⁺/CD8⁺ were lower, the differences were statistically significant between the two groups (t/χ²=1.999-22.720, all P＜0.05). Multivariate Logistic regression analysis showed that fever duration and WBC level were risk factors for RMPP, and CD4⁺/CD8⁺ ratio was a protective factor for RMPP (OR=1.962, 2.258 and 0.015 respectively, all P＜0.05). Subgroup analysis showed that the correlation between CD4⁺/CD8⁺ and RMPP complicated with PB was stable: the smaller the CD4⁺/CD8⁺ ratio, the greater the risk of RMPP complicated with PB. The ROC curve analysis showed that the area under the curve (AUC) of the CD4⁺/CD8⁺ ratio for predicting RMPP complicated with PB was 0.831 (95%CI:0.741-0.917), with a sensitivity of 85.25% and a specificity of 86.32%. Conclusion The ratio of CD4⁺/CD8⁺ is correlated with severity of MPP and is a protective factor for occurrence of RMPP and the smaller the ratio of CD4⁺/CD8⁺, the greater the risk of RMPP complicated with PB.

关键词

儿童 / 肺炎支原体肺炎 / 难治性 / CD4⁺/CD8⁺比值 / 塑型性支气管炎 / 疾病严重程度

Key words

children / Mycoplasma pneumoniae pneumonia / refractory / CD4⁺/CD8⁺ ratio / plastic bronchitis / severity of disease

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