2025 年第 3 期 第 20 卷

重症肺炎支原体肺炎儿童血清相关因子水平变化及临床意义

Changes and clinical significance of serum related factors in children with severe Mycoplasma pneumoniae pneumonia

作者：刘珂玫李婵刘杰霍静雨马毛毛

英文作者：Liu Kemei Li Chan Liu Jie Huo Jingyu Ma Maomao

单位：陕西省榆林市第一医院延安大学第二附属医院儿科，榆林718000

英文单位：Department of Pediatrics the First Hospital of Yulin Shaanxi Province Yan′an University Second Affiliated Hospital Yulin 718000 China

关键词：重症肺炎支原体肺炎；淋巴毒素样诱导表达蛋白与单纯疱疹病毒糖蛋白D竞争T淋巴细胞表达的疱疹病毒入侵介质受体；几丁质酶3样蛋白1

英文关键词：SevereMycoplasmapneumoniaepneumonia;Lymphotoxin-like,exhibitsinducibleexpression,competeswithherpessimplexvirusglycoproteinDforherpesvirus-entrymediator,areceptorexpressedbyTlymphocytes;Chitinase3-likeprotein1

• 摘要：

• 目的 探讨重症肺炎支原体肺炎（MPP）儿童血清淋巴毒素样诱导表达蛋白与单纯疱疹病毒糖蛋白D竞争T淋巴细胞表达的疱疹病毒入侵介质受体（LIGHT）和几丁质酶3样蛋白1（CHI3L1）的水平变化及临床意义。方法 选取2021年1月至2024年2月陕西省榆林市第一医院儿科收治的重症MPP（SMPP）患儿110例（SMPP组）和一般MPP（GMPP）患儿55例（GMPP组），SMPP患儿根据小儿危重病例评分分为非危重组（41例）、危重组（38例）和极危重组（31例），根据入院后28 d预后分为不良预后组（40例）和良好预后组（70例），采用酶联免疫吸附试验法检测入院时血清LIGHT、CHI3L1水平。以SMPP患儿不良预后为因变量，多因素非条件Logistic回归方法分析确定其影响因素，绘制受试者工作特征曲线评价血清LIGHT、CHI3L1水平对SMPP患儿不良预后的预测效能。结果 SMPP组血清LIGHT、CHI3L1水平均高于GMPP组［（8.2±1.8）ng/L比（4.3±0.8）ng/L、（2 917±732）ng/L比（1 825±388）ng/L］（均P＜0.001）。极危重组血清LIGHT、CHI3L1水平均高于危重组和非危重组，危重组均高于非危重组（均P＜0.05）。小儿危重病例评分高为SMPP患儿不良预后的独立保护因素，降钙素原高、LIGHT高、CHI3L1高均为独立危险因素（均P＜0.05）。血清LIGHT、CHI3L1水平联合预测SMPP患儿不良预后的曲线下面积为0.868，大于血清LIGHT、CHI3L1水平单独预测的0.781、0.784（均P<0.05）。结论 SMPP患儿血清LIGHT、CHI3L1水平升高，与病情程度和不良预后密切相关，血清LIGHT、CHI3L1水平联合对SMPP患儿不良预后有较高预测效能。

• Objective  To investigate the changes and clinical significance of serum lymphotoxin-like, exhibits inducible expression, competes with herpes simplex virus glycoprotein D for herpesvirus-entry mediator, a receptor expressed by T lymphocytes (LIGHT) and chitinase 3-like protein 1 (CHI3L1) levels in children with severe Mycoplasma pneumoniae pneumonia (MPP). Methods A total of 110 children with severe MPP (SMPP group) and 55 children with general MPP (GMPP group) admitted to the Department of Pediatrics, the First Hospital of Yulin, Shaanxi Province from January 2021 to February 2024 were selected. The children with SMPP were divided into non-critical group (41 cases), critical group (38 cases) and extremely critical group (31 cases) according to pediatric critical illness score. According to the outcome 28 days after admission, the children were further divided into poor prognosis group (40 cases) and good prognosis group (70 cases). The serum levels of LIGHT and CHI3L1 at admission were detected by enzyme-linked immunosorbent assay. With the poor prognosis of children with SMPP as the dependent variable, multivariate unconditional Logistic regression analysis was used to determine its influencing factors. The receiver operating characteristic curve was drawn to evaluate the efficacy of serum LIGHT and CHI3L1 levels in predicting the poor prognosis of children with SMPP. Results The serum levels of LIGHT and CHI3L1 in the SMPP group were higher than those in the GMPP group［(8.2±1.8)ng/L vs (4.3±0.8)ng/L, (2 917±732)ng/L vs (1 825±388)ng/L］(both P<0.001). The serum levels of LIGHT and CHI3L1 in extremely critical group were higher than those in critical group and non-critical group, and those in critical group were higher than those in non-critical group(all P<0.05). High pediatric critical illness score was an independent protective factor for poor prognosis in children with SMPP, and high procalcitonin, LIGHT, and CHI3L1 were independent risk factors for poor prognosis (all P<0.05). The area under the curve of the combination of serum LIGHT and CHI3L1 levels for predicting the poor prognosis of children with SMPP was 0.868, which was larger than 0.781 and 0.784 of serum LIGHT and CHI3L1 levels alone(both P<0.05). Conclusions  Children with SMPP have elevated serum levels of LIGHT and CHI3L1, which are closely related to disease severity and poor prognosis. The combination of serum levels of LIGHT and CHI3L1 has a high predictive value for poor prognosis in children with SMPP.