IL-17A对于儿童难治性肺炎支原体肺炎预测作用

doi:10.12372/jcp.2023.22e0032

摘要/Abstract

摘要：

目的探讨血白细胞介素（IL）-17A对儿童难治性肺炎支原体肺炎（RMPP）的预测价值。方法回顾性分析2019年1月至2021年10月收治的肺炎支原体肺炎（MPP）患儿的临床资料。将入组患儿分为MPP组和RMPP组，比较两组间感染相关指标差异，采用受试者工作特征（ROC）曲线评估相关指标预测RMPP的价值。结果纳入MPP 患儿63例，男43例、女20例，中位年龄4.9（1.8~12.0）岁。MPP组42例、RMPP组21例，两组间性别、年龄差异无统计学意义（P>0.05）。RMPP组大叶性实变、胸腔积液比例以及莫西沙星、糖皮质激素和纤维支气管镜的使用率均高于MPP组（P<0.05）。RMPP组患儿的IL-17A、IL-18、乳酸脱氨酶（LDH）、铁蛋白水平均高于MPP组，差异有统计学意义（P<0.05）。IL-18、IL-17A、LDH、铁蛋白水平预测RMPP的ROC曲线下面积（AUC）分别为0.85、0.81、0.80、0.69，对应截断值分别为472.0 pg/mL、13.4 pg/mL、389.0 UI/mL、251.0 pg/mL。结论血IL-17A≥13.4 pg/mL和IL-18≥472.0 pg/mL能相对准确地预测儿童RMPP，IL-18预测效能更高。

关键词: IL-17A, IL-18, 难治性肺炎支原体肺炎, 儿童

Abstract:

Objective To explore the predictive value of blood interleukin (IL)-17A in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods Clinical data of children with Mycoplasma pneumoniae pneumonia (MPP) admitted from January 2019 to October 2021 were retrospectively analyzed. The enrolled children were divided into the MPP and the RMPP group. The differences of infection-related indexes between the two groups were compared, and the value of these indicators in predicting RMPP was evaluated by ROC curves. Results A total of 63 children with MPP were included in the study, including 42 cases in MPP group and 21 cases in RMPP group. There were 43 males and 20 females with a median age of 4.9(1.8-12.0) years and no significant differences was found in gender and age between the two groups (P>0.05). The proportion of lobar consolidation, pleural effusion, moxifloxacin, glucocorticoid and bronchoscopy in RMPP group were higher than those in MPP group (P<0.05). Also, IL-17A, IL-18, LDH and ferritin levels in RMPP group were higher (P<0.05). The area under ROC curve (AUC) of IL-18 and IL-17A in predicting RMPP were 0.85, 0.81, 0.80 and 0.69 in the RMPP group, respectively, with corresponding cut-off values of 472.0 pg/mL, 13.4 pg/mL,389.0 UI/mL, and 251.0 pg/mL, respectively. Conclusions Serum IL-17A≥13.4 pg/mL and IL-18≥472 pg/mL were relatively accurate predictors of refractory mycoplasma pneumonia in children, and IL-18 has higher predictive efficacy.

Key words: IL-17A, IL-18, refractory Mycoplasma pneumoniae pneumonia, child

高龙飞, 张景丽, 吴晓杰, 吴会芳, 段晨初, 康军聪, 张中平. IL-17A对于儿童难治性肺炎支原体肺炎预测作用[J]. 临床儿科杂志, 2023, 41(5): 366-369.

GAO Longfei, ZHANG Jingli, WU Xiaojie, WU Huifang, DUAN Chenchu, KANG Juncong, ZHANG Zhongping. Predictive role of IL-17A in refractory Mycoplasma pneumoniae pneumonia in children[J]. Journal of Clinical Pediatrics, 2023, 41(5): 366-369.

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参考文献 19

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项目	MPP(n=42)	RMPP(n=21)	统计量	P
男[n(%)]	29(69.0)	14(66.7)	χ²=0.07	0.848
年龄[M(P₂₅~P₇₅)]/岁	4.2(2.0~11.5)	5.5(1.9~13.0)	Z=0.81	0.415
影像学表现[n(%)]
大叶性实变	12(28.6)	15(71.4)	χ²=10.50	0.001
肺不张	4(9.5)	3(14.3)	χ²=0.32	0.571
胸腔积液	2(4.7)	7(33.3)	χ²=9.33	0.002
气胸	1(2.4)	1(4.8)	-	1.000¹⁾
弥漫性点片状阴影	9(21.4)	6(28.6)	χ²=0.39	0.530
治疗[n(%)]
阿奇霉素	42(100)	11(52.4)	χ²=23.77	<0.001
莫西沙星	0(0)	17(81.0)	χ²=46.53	<0.001
糖皮质激素	23(54.8)	21(100)	χ²=13.60	<0.001
纤维支气管镜	5(11.9)	9(42.9)	χ²=7.76	0.005

项目	MPP组(n=42)	RMPP组(n=21)	Z值	P
IL-6/pg·mL^-1	1.8(0.9~6.5)	2.4(1.1~7.6)	1.50	0.132
TNF-α/pg·mL^-1	4.5(2.0~16.9)	7.2(3.8~18.8)	0.85	0.370
IL-17A/pg·mL^-1	4.2(3.6~9.8)	11.3(6.9~26.7)	2.44	0.015
LDH/UI·mL^-1	108.0(42.0~177.0)	255.0(102.0~341.0)	2.61	0.009
铁蛋白/pg·mL^-1	122.0(78.0~302.0)	412.0(210.0~745.0)	2.26	0.024
IL-18/pg·mL^-1	174.0(115.0~242.0)	422.0(186.0~669.0)	2.15	0.032
WBC/×10⁹·L^-1	6.2(3.9~7.6)	7.1(3.2~12.5)	1.01	0.305
CRP/mg·L^-1	13.3(4.4~30.8)	16.5(5.8~33.9)	1.61	0.109
PCT/μg·mL^-1	1.3(0.4~1.8)	1.2(0.8~2.2)	0.69	0.487

指标	截断值	灵敏度/%	特异度/%	AUC(95%CI)	P
LDH	389.0 UI·mL^-1	62.3	94.6	0.80(0.78~0.92)	0.001
铁蛋白	251.0 pg·mL^-1	68.5	65.4	0.69(0.61~0.79)	0.023
IL-18	472.0 pg·mL^-1	79.8	91.2	0.85(0.81~0.92)	<0.001
IL-17A	13.4 pg·mL^-1	78.4	89.2	0.81(0.76~0.89)	0.011