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目的:探讨小儿难治性支原体肺炎(RMPP)血清肿瘤坏死因子-α(TNF-α)、白细胞介素-4(IL-4)、白细胞介素-10(IL-10)水平变化及临床意义。方法:选自我院2013年1月至2016年1月收治的90例RMPP住院患儿设为RMPP组,根据肺炎严重指数(PSI)评分标准分为重症肺炎组(30例)和非重症肺炎组(60例),并选择同期健康体检的健康儿童为50例对照组。并对患儿进行跟踪、随访,收集47例患儿作为RMPP恢复期组,采用酶联免疫吸附法(ELISA)检测各组血清中TNF-α、IL-4、IL-10的水平变化。结果:RMPP组、RMPP恢复期组患者血清中TNF-α、IL-4和IL-10水平明显高于对照组(P<0.05);RMPP组患者血清中以上三个指标均明显高于RMPP恢复期组(P<0.05);重症肺炎组有纤维化改变和无纤维化的患儿血清中TNF-α、IL-4和IL-10水平均高于非重症肺炎组患儿血清(P<0.05);重症肺炎组和非重症肺炎组内出现纤维化改变的患儿血清中TNF-α、IL-4和IL-10水平均高于无纤维化患儿(P<0.05);PSI评分与TNF-α、IL-4和IL-10的水平呈正相关(P<0.05)。结论:TNF-α、IL-4和IL-10水平参与了RMPP的发病过程,它们高水平表达与病情严重程度密切相关,可以作为早期诊断RMPP及控制病情发展的重要依据。
Objective: To investigate the changes of serum levels of tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4) and interleukin-10 (IL-10) in children with refractory mycoplasma pneumonia (RMPP) . Methods: Ninety RMPP hospitalized children who were selected from our hospital from January 2013 to January 2016 were enrolled as the RMPP group and were divided into severe pneumonia group (n = 30) and non-severe pneumonia group according to the severe pneumonia index (PSI) (60 cases), and healthy children of the same period were selected as the control group. Forty-seven children were recruited as RMPP recovery group, and the levels of TNF-α, IL-4 and IL-10 in serum were detected by enzyme-linked immunosorbent assay (ELISA). Results: Serum levels of TNF-α, IL-4 and IL-10 in RMPP group and RMPP recovery group were significantly higher than those in control group (P <0.05). The above three indexes in RMPP group were significantly higher than those in RMPP recovery group (P <0.05). Serum levels of TNF-α, IL-4 and IL-10 in patients with severe pneumonia were significantly higher than those in non-severe pneumonia group (P <0.05) ). The levels of serum TNF-α, IL-4 and IL-10 in patients with severe pneumonia and non-severe pneumonia were significantly higher than those without fibrosis (P <0.05). The scores of PSI and TNF -α, IL-4 and IL-10 levels were positively correlated (P <0.05). CONCLUSION: The levels of TNF-α, IL-4 and IL-10 are involved in the pathogenesis of RMPP. Their high level of expression is closely related to the severity of the disease.