外周血炎症因子水平在重症肺炎支原体肺炎合并胸腔积液患儿临床转归中的意义

Changes in peripheral blood inflammatory cytokines and their relationship with clinical outcomes in children with severe mycoplasmal pneumoniae pneumonia complicated by pleural effusion

摘要:

目的 探讨重症肺炎支原体肺炎（SMPP）合并胸腔积液患儿外周血炎症因子的变化，以及与临床转归的关系。方法 回顾性选取2020年2月—2023年12月南充市中心医院收治的200例SMPP合并胸腔积液的患儿作为观察组，另选同期50例SMPP非合并胸腔积液患儿作为对照组。比较患儿的白细胞介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-8（IL-8）、肿瘤坏死因子α（TNF-α）、可溶性白细胞介素-2受体（sIL-2R）水平；对比分析观察组不同治疗反应、临床结局患儿的炎症因子水平；采用多因素一般Logistic回归模型分析治疗反应和临床结局的影响因素。结果 观察组的IL-6、IL-8、PCT、CRP、TNF-α和sIL-2R水平均高于对照组（P <0.05）。治疗7 d后，无效组的IL-6、PCT、CRP、IL-8、TNF-α、sIL-2R水平均高于有效组（P <0.05）。出院时，未痊愈组的IL-6、PCT、CRP、IL-8、TNF-α、sIL-2R水平均高于痊愈组（P <0.05）。多因素一般Logistic回归分析结果显示：sIL-2R高水平［O^R =7.608（95% CI：1.418，40.820）］、IL-6高水平［O^R =1.591（95% CI：1.294，1.958）］、IL-8高水平［O^R =1.240（95% CI：1.072，1.434）］、PCT高水平［O^R =3.555（95% CI：1.174，10.763）］均是患儿治疗无效的危险因素（P <0.05）；PCT高水平［O^R =3.397（95% CI：1.069，10.793）］、IL-6高水平［O^R =1.601（95% CI：1.279，2.003）］、IL-8高水平［O^R =1.216（95% CI：1.038，1.424）］、TNF-α高水平［O^R =1.236（95% CI：1.060，1.441）］均是患儿未痊愈的危险因素（P <0.05）。结论 SMPP合并胸腔积液患儿的外周血炎症因子水平与临床转归密切相关，监测IL-6、IL-8、PCT和TNF-α水平可为评估治疗效果和疾病短期转归提供重要依据，从而辅助指导临床治疗策略的调整与优化。

Abstract:

Objective To investigate the changes in peripheral blood inflammatory factors in children with severe mycoplasmal pneumoniae pneumonia (SMPP) complicated by pleural effusion and their relationship with clinical outcomes.Methods A retrospective study was conducted, in which 200 children with SMPP complicated by pleural effusion who were admitted to Nanchong Central Hospital from February 2020 to December 2023 were enrolled as the observation group. Additionally, 50 children with SMPP without pleural effusion admitted during the same period were selected as the control group. The levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), and soluble interleukin-2 receptor (sIL-2R) were compared between the two groups. Moreover, the levels of inflammatory factors were analyzed among children in the observation group with different treatment responses and clinical outcomes, and the relationship between inflammatory levels and clinical outcomes was explored.Results The levels of IL-6, IL-8, PCT, CRP, TNF-α, and sIL-2R in the observation group were significantly higher than those in the control group (all P < 0.05). Seven days after treatment, the peripheral blood levels of IL-6, PCT, CRP, IL-8, TNF-α, and sIL-2R in the ineffective treatment group were significantly higher than those in the effective treatment group (all P < 0.05). At discharge, the peripheral blood levels of IL-6, PCT, CRP, IL-8, TNF-α, and sIL-2R in the non-recovery group were significantly higher than those in the recovery group (all P < 0.05). Multivariate binary logistic regression analysis showed that high levels of sIL-2R [O^R = 7.608 (95% CI: 1.418, 40.820) ], IL-6 [O^R = 1.591 (95% CI: 1.294, 1.958) ], IL-8 [O^R = 1.240 (95% CI: 1.072, 1.434) ], and PCT [O^R = 3.555 (95% CI: 1.174, 10.763) ] were independent risk factors for ineffective treatment response in children (all P < 0.05); while high levels of PCT [O^R = 3.397 (95% CI: 1.069, 10.793) ], IL-6 [O^R = 1.601 (95% CI: 1.279, 2.003) ], IL-8 [O^R = 1.216 (95% CI: 1.038, 1.424) ], and TNF-α [O^R = 1.236 (95% CI: 1.060, 1.441) ] were independent risk factors for non-recovery as the clinical outcome in children (all P < 0.05).Conclusion The peripheral blood inflammatory cytokine levels in children with SMPP complicated by pleural effusion are closely related to clinical outcomes. Monitoring the levels of IL-6, IL-8, PCT, and TNF-α can provide important information for assessing treatment effectiveness and short-term clinical outcomes, thereby aiding in the adjustment and optimization of clinical treatment strategies.