肺炎支原体肺炎患儿血清mi...与病情严重程度的相关性分析_于雪.pdf

DOI:10 3969/j issn 1671 4695 2023 07 016文章编号:1671 4695(2023)07 0730 04肺炎支原体肺炎患儿血清 mi 126 5p、SPP1 表达水平与病情严重程度的相关性分析于雪1孟繁1蔡天池1孔德胜2赵林1*(1 北大荒集团总医院儿内科黑龙江哈尔滨150088;2 哈尔滨医科大学附属第四医院血液科黑龙江哈尔滨150001)【摘要】目的探讨肺炎支原体肺炎(MPP)患儿血清微小 NA 126 5p(mi 126 5p)、分泌性磷蛋白 1(SPP1)表达及与病情严重程度的相关性。方法回顾性选取 2018 年 6 月至 2021 年 10 月在北大荒集团总医院治疗的199 例 MPP 患儿作为观察对象，急性期 106 例，缓解期 93 例，根据临床肺部感染评分(CPIS)将急性期 MPP 患儿分为轻症组(CPIS6 分)59 例和重症组(CPIS 6 分)47 例，另选取同期健康体检儿童 50 例作为对照组。采用 T qPC 检测血清 mi 126 5p 水平;酶联免疫吸附试验检测血清 SPP1、超敏 C 反应蛋白(hs CP)、白细胞介素(IL)6、IL 1 水平;Pearson 法分析急性期 MPP 患儿血清 mi 126 5p、SPP1 与 hs CP、IL 6、IL 1 水平的相关性;Spearman法分析 mi 126 5p、SPP1 水平与 CPIS 评分的相关性;采用受试者工作特征(OC)曲线分析血清 mi 126 5p、SPP1对重症 MPP 患儿的预测价值。结果对照组、缓解期组、急性期组观察对象血清 mi 126 5p、SPP1、hs CP、IL 6、IL 1 水平比较，差异均有统计学意义(P 0 05)。与轻症 MPP 患儿比较，重症 MPP 患儿血清 mi 126 5p、SPP1、hs CP、IL 6、IL 1 水平及 CPIS 评分显著升高，差异均有统计学意义(P 0 05)。相关性分析显示，急性期 MPP患儿血清 mi 126 5p 与 SPP1 呈正相关，且 mi 126 5p、SPP1 与 hs CP、IL 6、IL 1 水平及 CPIS 评分呈正相关(P 0 001)。血清 mi 126 5p、SPP1 联合诊断重症 MPP 患儿曲线下面积为 0 935，敏感度为 86 79%，特异度为91 53%。结论MPP 患儿血清 mi 126 5p、SPP1 水平升高，与患儿疾病严重程度有关，可作为 MPP 患儿病情评估的标志物。【关键词】微小 NA 126 5p分泌性磷蛋白 1肺炎支原体肺炎儿童Correlation analysis of serum mi 126 5p and SPP1 expression levels and disease severity in children with Mycoplasma pneumoniaepneumonia YU Xue，MENG Fan，CAI Tian chi，et al Department of Pediatrics，General Hospital of Beidahuang Group，Harbin Heilongjiang150088，China【Abstract】ObjectiveTo investigate the expression of serum microNA 126 5p(mi 126 5p)and secreted phosphoprotein 1(SPP1)in children with Mycoplasma pneumoniae pneumonia(MPP)and their correlation with disease severity MethodsA total of 199 chil-dren with MPP who were treated in General Hospital of Beidahuang Group from June 2018 to October 2021 were collected as the observation ob-jects，including 106 in the acute stage and 93 in the remission stage According to the clinical pulmonary infection score(CPIS)，children with a-cute MMP were grouped into mild group(CPIS6 points)with 59 cases and severe group(CPIS 6 points)with 47 cases In addition，50healthy children were gathered as the control group The serum mi 126 5p level was detected by T qPC，serum SPP1，hypersensitive C reactive protein(hs CP)，interleukin(IL)6，and IL 1 levels were detected by enzyme linked immunosorbent assay，the correlation ofmi 126 5p，SPP1 and hs CP，IL 6，IL 1 levels in children with acute MPP was analyzed by Pearson method，the correlation betweenthe levels of mi 126 5p and SPP1 and the CPIS score was analyzed by Spearman method，the predictive value of serum mi 126 5p andSPP1 in children with severe MPP was analyzed by receiver operating characteristic(OC)curve esultsThere were statistically significantdifferences in the levels of serum mi 126 5p，SPP1，hs CP，IL 6，and IL 1 among the observation subjects in the control group，theremission group，and the acute group，the differences were statistically significant(P 005);compared with children with mild MPP，the lev-els of serum mi 126 5p，SPP1，hs CP，IL 6，IL 1 and CPIS score in children with severe MPP were significantly higher，the differ-ences were statistically significant(P 0 05);correlation analysis showed that serum mi 126 5p was positively correlated with SPP1 in chil-dren with acute MPP，and mi 126 5p and SPP1 were positively correlated with hs CP，IL 6，IL 1 levels and CPIS score(P 0001);the area under the curve of serum mi 126 5p and SPP1 in the diagnosis of children with severe MPP was 0935，the sensitivity was 8679%，and the specificity was 91 53%ConclusionThe serum levels of mi 126 5p and SPP1 in children with MPP are elevated，which are relat-ed to the severity of the disease in children，and may be used as markers for the assessment of the disease of children with MPP【Key words】MicroNA 126 5p;Secreted phosphoprotein 1;Mycoplasma pneumoniae pneumonia;Children基金项目:中国博士后科学基金面上项目(编号:2019M661305)*通讯作者:赵林，E mail:zhaolin2301163 com支原体肺炎(Mycoplasma pneumoniae pneumonia，MPP)为儿科的常见疾病，5%20%的儿童出现呼吸道感染与 MPP 有关，而 MPP 发病机制复杂，若治疗不及时可发展为重症肺炎，严重影响儿童身心健康，故准确评估患儿病情具有重要意义1。mi 126 5p 为微小NA，与多种疾病的发生密切相关，研究显示，mi 1265p 在急性胰腺炎患者血清中水平升高，与患者严重程度有关2。另有研究显示，mi 126 与哮喘有关，抑037Journal of Clinical and Experimental Medicine Vol22，No7Apr2023制 mi 126 表达可改善卵清蛋白诱导的哮喘小鼠免疫平衡和肺组织纤维化3。因而本研究推测 mi 126 5p 与肺炎有关。分泌性磷蛋白 1(secreted phosphorpro-tein 1，SPP1)又称骨桥蛋白，主要调节骨代谢，最新研究显示，其在特发性肺纤维化(idiopathic pulmonary fi-brosis，IPF)下叶中的巨噬细胞中高表达，对 IPF 中的肺纤维化起重要作用，表明 SPP1 在肺部疾病中发挥重要作用4。然而关于 mi 126 5p、SPP1 在 MPP 患儿中的研究尚未见报道，本研究检测 MPP 患儿血清 mi 126 5p、SPP1 表达情况，探讨 mi 126 5p、SPP1 表达情况与病情严重程度之间的相关性，为 MPP 的临床研究及治疗提供参考。1资料与方法1 1一般资料回顾性选择 2018 年 6 月至 2021 年 10月在北大荒集团总医院治疗的 199 例 MPP 患儿作为观察对象，其中男性 115 例，女性 84 例;年龄 1 13 岁，平均年龄(5 60 1 85)岁;急性期 106 例，缓解期 93 例。根据临床肺部感染评分(clinical pulmonary infectionscore，CPIS)5 将急性期 MMP 患儿分为轻症组(CPIS6 分)59 例和重症组(CPIS 6 分)47 例。另选取同期健康体检儿童 50 例作为对照组，其中男性 27 例，女性23 例;年龄 1 12 岁，平均年龄(5 70 1 9)岁。本研究经过北大荒集团总医院伦理委员会批准。1 2纳入与排除标准纳入标准:(1)符合 MPP 患儿相关诊断6;(2)有发热、肺部啰音、咳嗽等症状体征;(3)所有患儿家属或监护人知情并同意。排除标准:(1)既往有肺结核、支气管哮喘、呼吸道慢性炎症等病史;(2)近期服用过免疫调节药物、免疫抑制剂;(3)合并心、肝等脏器受损或有自身免疫系统疾病;(4)恶性肿瘤。1 3主要试剂总 NA 抽提试剂(0011)、白细胞介素(interl