| 摘要: |
| 目的:探讨肺炎支原体肺炎(MPP)患儿血清25 羟基维生素D3 [25-(OH)D3 ] 水平与辅助性T 淋巴细胞17(Th17) / 调节
性T 细胞(Treg)免疫平衡及肺外表现的关系。方法:回顾性分析221 例MPP 患儿的临床资料。依据患儿经大环内酯类抗菌药
物规范治疗7 天后是否仍存在MPP 临床征象分为难治性MPP( RMPP) 组和MPP 组。比较患儿临床资料,logistic 回归分析
25-(OH)D3 水平与RMPP 关联性。依据患儿住院期间有无肺外并发症分为肺外表现组和无肺外表现组。线性回归分析
25-(OH)D3 、Th/ Treg 对肺外表现的影响;log-binomial 模型分析25-(OH)D3 、Th/ Treg 对RMPP 及肺外表现风险比。结果:RMPP
组25-(OH)D3 水平低于MPP 组,肺外表现、C 反应蛋白、D-二聚体、乳酸脱氢酶水平、胸腔积液、肺实变、大叶性肺不张发生率
高于MPP 组(P<0. 05)。高25-( OH) D3 是降低RMPP 风险的保护因素( P <0. 05)。肺外表现组Th1、Th17、白细胞介素-2
(IL-2)、IL-4、IL-6、IL-17、干扰素-γ 水平升高,Th2、Treg、IL-10 水平降低(P<0. 05)。肺外表现风险与25-(OH)D3 、Treg 水平呈负
相关,与Th17、Th17/ Treg 正相关。高25-(OH)D3 水平肺外表现风险可降至0. 51 倍,高Th17/ Treg 水平肺外表现风险可升至
1. 86 倍。结论:血清25-(OH)D3 与Th17/ Treg 水平可作为肺外表现风险预测指标指导药物治疗决策。 |
| 关键词: 肺炎支原体肺炎 肺外表现 25-羟基维生素D3 儿童 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.10.013 |
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| 基金项目: |
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| Correlation Between 25-Hydroxyvitamin D3 Levels, Immune Balance and Extrapulmonary Manifestation ofChildren with Mycoplasma Pneumoniae Pneumonia and Drug Treatment Strategies |
| Xie Rong |
| ((Fuyang Cancer Hospital, Anhui Fuyang 236000, China)) |
| Abstract: |
| Objective: To probe into the correlation between serum 25-hydroxyvitamin D3 (25-(OH)D3 ) levels, T-helper lymphocyte
17 (Th17) / regulatory T cell (Treg) immune balance, and extrapulmonary manifestation in children with Mycoplasma pneumoniae
pneumonia (MPP). Methods: Retrospective analysis was performed on clinical data of 221 children with MPP. According to the
presence or absence of MPP clinical signs after 7 d of standardized treatment with macrolide antibiotics, the children were divided into
the refractory MPP (RMPP) group and non-refractory MPP group. Clinical data were compared, and logistic regression model was used
to analyze the correlation between 25-( OH) D3 levels and refractory MPP. Additionally, the children were divided into the
extrapulmonary manifestation group and non-extrapulmonary manifestation group based on the presence or absence of extrapulmonary
complications during hospitalization. Linear regression was used to analyze the effects of 25-(OH)D3 and Th/ Treg on extrapulmonary
manifestation; log-binomial model was used to analyze the risk ratios of 25-(OH)D3 and Th/ Treg for refractory MPP and extrapulmonary
manifestation. Results: The 25-(OH) D3 level in RMPP group was lower than that in MPP group. The rates of extrapulmonary
manifestation, C-reactive protein, D-dimer, lactate dehydrogenase levels, pleural effusion, pulmonary consolidation, and lobar
pneumonia were higher in RMPP group than those in MPP group (P <0. 05). High 25-(OH)D3 level was the protective factor for
reducing the risk of refractory MPP (P < 0. 05). Compared with the non-extrapulmonary manifestation group, the extrapulmonary
manifestation group had significantly elevated levels of Th1, Th17, interleukin-2 (IL-2), IL-4, IL-6, IL-17, and interferon-γ, and
significantly decreased levels of Th2, Treg, and IL-10 (P<0. 05). The risk of extrapulmonary manifestation was negatively correlated
with 25-(OH)D3 and Treg levels, and positively correlated with Th17 and Th17/ Treg levels. The risk of extrapulmonary manifestation in
children with high 25-(OH)D3 levels was reduced to 0. 51 times, while that in children with high Th17/ Treg levels was increased to
1. 86 times. Conclusion: Serum 25-(OH)D3 and Th17/ Treg levels can serve as predictive indicators for the risk of extrapulmonary
manifestation, which facilitates the guidance of pharmacotherapeutic decision-making. |
| Key words: Mycoplasma pneumoniae pneumonia extrapulmonary manifestation 25-hydroxyvitamin D3 children |
