摘要
目的探讨重症支原体肺炎患儿合并肺部真菌感染的病原学特征及T淋巴细胞免疫特征。方法回顾性纳入2022年7月—2024年7月收治于太原市中心医院儿科的37例重症支原体肺炎合并真菌感染的患儿为A组;另纳入同期无任何并发症的50例重症支原体肺炎患儿为B组,同时随机选取50例健康体检儿童为C组。分析A组的病原学特征;对比3组儿童的炎症指标[中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、淀粉样蛋白A(serumamyloid A,SAA)、红细胞沉降率(erythrocyte sedimentation Rate,ESR)]、肺功能指标[呼气峰流速(peak expiratory flow,PEF)、最大通气量(maximum voluntary ventilation VCMax,MVV)、第1秒用力呼气量占所有呼气量的比例(forced expiratory volume in one second to forced vital capacity ratio,FEV1/FVC)]、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))及营养状况指标(维生素A、维生素D)。结果A组37例重症支原体肺炎合并肺部真菌感染的患儿共检出39株真菌,其中白念珠菌最多,其余依次为烟曲霉、毛霉、近平滑念珠菌和肺孢子菌。A、B两组患儿NLR、SAA、ESR、CD8^(+)水平均显著高于C组儿童,且A组显著高于B组,均存在显著差异(P<0.05);A、B两组患儿PEF、MVV、FEV1/FVC、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、维生素A、维生素D水平均显著低于C组儿童,且A组显著低于B组,差异均有统计学意义(P<0.05)。ROC结果显示:NLR、SAA、ESR、PEF、MVV、FEV1/FVC、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、维生素A、维生素D预测重症支原体肺炎患儿合并肺部真菌感染均具有统计学意义(P<0.05)。结论重症支原体肺炎合并肺部真菌感染以白念珠菌感染为主,患儿体内存在较强的炎症反应与免疫功能紊乱,肺功能差且营养状况不佳。因此临床治疗需早期监测各项指标,尽早采取减轻炎症及调节免疫等综合治疗措施,重视真菌防治,改善患儿预后。
Objective To investigate the pathogenic characteristics and T lymphocyte immune features in children with severe mycoplasmal pneumonia complicated by pulmonary fungal infection.Methods Retrospective inclusion of 37 children with severe mycoplasmal pneumonia complicated by fungal infection admitted to Taiyuan Central Hospital pediatric department from July 2022 to July 2024 formed Group A.An additional 50 children with severe mycoplasmal pneumonia without complications during the same period formed Group B.Concurrently,50 healthy children undergoing routine physical examinations were randomly selected to form Group C.Pathogenic characteristics of Group A were analyzed.Inflammatory markers[neutrophil-to-lymphocyte ratio(NLR),serum amyloid A(SAA),erythrocyte sedimentation rate(ESR)],pulmonary function indicators[peak expiratory flow(PEF),maximum voluntary ventilation(MVV),forced expiratory volume in one··second to forced vi talcap ci yratio(FEV1/FVC)],T ly phocy esubse ts(CD^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),and n triti nalst tusindicator(v taminA,vita in D).R esultsIn Gr up A,39 fun al s trainsw rede ectedam ng 37chil re wi hsever mycopla smal p eumonia c omplic te d by pulmon ry fu gal inf ction.Candi d aalbicans was the most pr va lent,follo ed by As ergillus fu igatus,Mucorales,Can ida parap ilosis,and Pneumocys is.Both G oupsA and B e hibi tedsig ifi cantlyh herlevel o fNLR,SAA,ESR a nd CD8^(+)co p redto Grou C,with Group A s how ngs i ni fic nt ly hi hervalue th nGroup B(P<0.05).The level s o fPEF,MVV,F V1/FVC,CD3^(+),CD4^(+),CD^(+)/CD8^(+),vitamin A,and vitami n D were sign ficantl lowe in G r o p sA a d B tha n i nG ro pC,w th G rou pA bei ngsi g ifi can l yl owerthan Grou B.All d iff rences w e est t stic ll signi ca t(P<0.).ROC analy sr ealedthat N,SAA,ESR,PEF,MVV,FEV1/FV CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),vit mi A,a dvitamin D l vels w erestatistica lysignifica t pr edi t o rsof pulm na ry f un ga lin fe tion i nch ldren w ithse eremycoplas ma lpneumonia(P<0.05).Co nclusi Severe mycoplas lp umoniacompli tedby pul naryfungal infection is predo nantly caused by Candid albicans.Affected chil enex bit intense inflamma o ryresponses,im munedysfunction,po pulm aryfunct on,a dmalnu rition.Ther fore,clin calm anagem ntrequires e arlym nitori ngof r elevan t indic ato s,pr m ptimple men a tion of com preh ensiv ethe rape uticme sures to r ducein fla matio nand m odu ateimmunity,e phasison fu galpreve tionand tre tment,an impro ementof patient progno s.
作者
赵永艳
姚洁
ZHAO Yongyan;YAO Jie(Pediatrics Department,Taiyuan Central Hospital,Taiyuan 030009,China;Infectious Diseases Department,Taiyuan Central Hospital,Taiyuan 030009,China)
出处
《中国真菌学杂志》
2025年第6期645-651,共7页
Chinese Journal of Mycology
关键词
重症支原体肺炎
真菌感染
病原学特征
T淋巴细胞
免疫特征
severe my oplasmal pneumonia
funga l infection
pat hogenic characteristics
T lympho ytes
im munologicalfeatures
