血清IL-6、RANTES与儿童难治性肺炎支原体肺炎的关系

张松林; 熊蕾蕾; 余燕娟; 郭燕军

doi:10.16766/j.cnki.issn.1674-4152.002944

血清IL-6、RANTES与儿童难治性肺炎支原体肺炎的关系

doi: 10.16766/j.cnki.issn.1674-4152.002944

郑州大学附属儿童医院河南省儿童医院郑州儿童医院呼吸内科，河南郑州 450000

基金项目:

河南省医学科技攻关计划联合共建项目 LHGJ20190919

详细信息

通讯作者:
张松林，E-mail：dfrgfg@126.com

中图分类号: R725.6 R563.15
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- 文章访问数: 302
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-03
- 网络出版日期: 2023-05-31

Expression of serum IL-6 and RANTES in children with refractory pneumonia caused by mycoplasma pneumoniae and their relationship with prognosis

Department of Respiratory, Children ' s Hospital Affiliated of Zhengzhou University, Henan Provincial Children ' s Hospital, Zhengzhou Children ' s Hospital, Zhengzhou, Henan 450000, China

摘要

摘要: 目的探讨难治性肺炎支原体肺炎(RMPP)的影响因素, 分析血清白介素6(IL-6)、受激活调节正常T细胞表达和分泌因子(RANTES)对RMPP的诊断价值。方法选取2019年3月—2021年4月收治于郑州大学附属儿童医院的70例肺炎支原体肺炎(MPP)患儿, 根据诊断标准分为MPP组(34例)和RMPP组(36例)。对RMPP产生的危险因素进行单因素分析, 差异有统计学意义的指标进一步行多因素logistic回归分析, 并绘制ROC曲线分析血清IL-6、RANTES对RMPP的诊断价值。结果 RMPP患儿发热持续时间>10 d占比及血清IL-6、RANTES水平高于MPP组, 差异有统计学意义(均P < 0.05)。多因素logistic回归分析显示, 血清IL-6(OR=2.451, 95% CI：1.856~3.046)、RANTES(OR=2.678, 95% CI：1.953~3.403)为RMPP发生的影响因素。ROC曲线分析结果显示, 血清IL-6、RANTES及两者联合预测RMPP发生的AUC分别为0.686、0.701、0.824。结论血清IL-6、RANTES水平较高是RMPP发生的危险因素, 两者联合检测用于诊断RMPP具有较高的临床价值。
- 难治性肺炎支原体肺炎 /
- 白介素6 /
- 受激活调节正常T细胞表达和分泌因子 /
- 预后
Abstract: Objective To explore the influencing factors of refractory mycoplasma pneumoniae pneumonia (RMPP), and analyze the diagnostic value of serum interleukin-6 (IL-6), activated normal T cell expression and secretion factors (RANTES) in RMPP. Methods A total of 70 children with mycoplasma pneumoniae pneumonia (MPP) admitted to the Affiliated Children ' s Hospital of Zhengzhou University from March 2019 to April 2021 were selected and divided into MPP group (34 cases) and RMPP group (36 cases) according to diagnostic criteria. The risk factors of RMPP were analysed by univariate analysis, and differences were analysed by multivariate logistic regression. In addition, the receiver operating characteristic curve (ROC) was drawn to analyse the diagnostic value of serum IL-6 and RANTES for RMPP. Results The proportion of fever duration >10 days and serum IL-6, RANTES levels in children with RMPP were higher than those in the MPP group, and the differences were statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that serum IL-6 (OR=2.451, 95% CI: 1.856-3.046) and RANTES (OR=2.678, 95% CI: 1.953-3.403) were the risk factors for the occurrence of RMPP. ROC showed that serum IL-6, the AUCs of RANTES and their combination in evaluating the prognosis of RMPP patients were 0.686, 0.701 and 0.824, respectively. Conclusion Higher levels of serum IL-6 and RANTES are the risk factors for the occurrence of RMPP, and their combined detection has high clinical value in the diagnosis of RMPP.
- Refractory Mycoplasma pneumoniae pneumonia /
- Interleukin-6 /
- Regulated on activation in normal T-cell expressed and secreted /
- Prognosis

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图 1 血清IL-6、RANTES单独及两者联合预测RMPP发生的ROC曲线

Figure 1. ROC curve of of single and combined detection of serum IL-6 and RANTES for predicting RMPP occurrenc

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表 1 MPP患儿发生RMPP的单因素分析

Table 1. Univariate analysis of the occurrence of RMPP in children with MPP

组别	例数	性别[例(%)]		年龄(x±s, 岁)	发热持续时间>10 d[例(%)]	剧烈咳嗽[例(%)]	喘促[例(%)]	精神状态差[例(%)]	全身皮疹[例(%)]	中性粒细胞比例异常[例(%)]
组别	例数	男	女	年龄(x±s, 岁)	发热持续时间>10 d[例(%)]	剧烈咳嗽[例(%)]	喘促[例(%)]	精神状态差[例(%)]	全身皮疹[例(%)]	中性粒细胞比例异常[例(%)]
MPP组	34	18(52.94)	16(47.06)	5.19±1.87	11(32.35)	13(38.24)	10(29.41)	9(26.47)	3(8.82)	11(32.35)
RMPP组	36	20(55.56)	16(44.44)	5.24±2.04	21(58.33)	14(38.89)	13(36.11)	11(30.56)	9(25.00)	18(50.00)
统计量		0.048^a		0.107^b	4.756^a	0.003^a	0.356^a	0.413^a	3.221^a	2.244^a
P值		0.826		0.915	0.029	0.955	0.551	0.705	0.073	0.134

组别	例数	WBC异常[例(%)]	CRP(x±s, mg/L)	肺部淋巴结肿大[例(%)]	胸腔积液[例(%)]	云絮状阴影[例(%)]	PCT(x±s, ng/mL)	LDH(x±s, U/L)	IL-6(x±s, μg/mL)	RANTES(x±s, ng/mL)
MPP组	34	5(14.71)	33.23±4.26	6(17.65)	3(8.82)	12(35.29)	0.16(0.09, 0.23)	295.23±20.25	13.85±3.65	28.16±5.47
RMPP组	36	8(22.22)	35.23±6.57	9(25.00)	8(22.22)	17(47.22)	0.21(0.08, 0.34)	305.47±30.41	31.56±4.92	35.64±6.15
统计量		0.653^a	1.501^b	0.561^a	2.370^a	1.025^a	1.942^b	1.648^b	17.283^b	5.365^b
P值		0.419	0.138	0.454	0.124	0.311	0.055	0.104	<0.001	<0.001
注：^a为χ²值，^b为t值。

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表 2 变量赋值表

Table 2. Variable assignment table

变量	赋值方法
RMPP	未发生=0，发生=1
发热持续时间>10 d	否=0，是=1
IL-6	以实际值赋值
RANTES	以实际值赋值

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表 3 MPP患儿发生RMPP的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of RMPP in children with MPP

变量	B	SE	Wald χ²	P值	OR值	95% CI
发热持续时间>10 d	0.059	0.067	0.775	0.083	1.061	0.842~1.280
IL-6	0.997	0.524	3.620	＜0.001	2.710	1.856~3.564
RANTES	0.985	0.566	3.029	＜0.001	2.678	1.953~3.403

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表 4 血清IL-6、RANTES单独及联合检测对RMPP发生的预测价值

Table 4. Predictive value of single and combined detection of serum IL-6 and RANTES for the occurrence of RMPP

项目	最佳截断值	灵敏度(%)	特异度(%)	准确度(%)	AUC	P值	95% CI
血清IL-6	41.23 μg/mL	70.59(24/34)	72.22(26/36)	71.43(50/70)	0.686	0.044	0.520~0.853
RANTES	3.74 ng/mL	73.53(25/34)	77.78(28/36)	75.71(53/70)	0.701	0.029	0.540~0.863
两者联合		79.41(27/34)	83.33(30/36)	81.42(57/70)	0.824	＜0.001	0.688~0.959

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