肺炎患儿外周血超敏C反应蛋白、降钙素原及细胞免疫指标变化及意义

摘要

Objective To observe the changes of high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), T lymphocyte subsets and CD4+ CD25+ regulatory T cells (Treg) in peripheral blood and their association with pneumonia in children. Methods Ninety-two children with pneumonia were divided into bacterial pneumonia group (38 cases), mycoplasma pneumonia group (29 cases) and viral pneumonia group (25 cases). The levels of hs-CRP, PCT, T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and CD4+CD25+ Treg were tested by immune scatter turbidimetry, enzyme-linked fluorescent assay and flow cytometry, and compared with normal control group (30 cases). Results The levels of CD3+, CD4+ lymphocytes and the ratio of CD4+/CD8+ in bacterial pneumonia group, mycoplasma pneumonia and viral pneumonia group were lower than those in the control group (all P＜0.01). The levels of CD8+ lymphocytes and hs-CRP in bacterial pneumonia group and mycoplasma pneumonia group were higher than those in the control group (all P＜0.01). The levels of CD8+ lymphocytes and hs-CRP in viral pneumonia group showed no significant change compared with the control group (P＞0.05). The levels of PCT and the positive rate of PCT in bacterial pneumonia group were significantly higher than those in mycoplasma pneumonia group and viral pneumonia group and the differences were statistically significant (all P＜0.01). The levels of CD4+CD25+ Treg in three pneumonia groups were significantly higher than those in the control group (all P＜0.01). Conclusions Hs-CRP and PCT are helpful to a certain extent to identify early childhood pneumonia caused by different pathogens. The specificity of PCT for the early diagnosis of bacterial infection in children was significantly higher than hs-CRP. Immune injury played a certain role in pneumonia in children.%目的 观察肺炎患儿外周血超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、T淋巴细胞亚群及CD4+CD25+调节性T细胞(regulatory T cell,Treg)水平变化,探讨其与儿童肺炎的关系.方法 入选细菌性肺炎38例、支原体肺炎29例和病毒性肺炎25例,共92例肺炎患儿,应用免疫散射比浊法、酶联荧光分析法和流式细胞术检测患儿外周血hs-CRP、PCT、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)和CD4+CD25+ Treg细胞水平(CD4+ CD25+ Treg占CD4+T细胞百分比),并与30例正常对照儿童进行比较.结果 肺炎患儿的CD3+、CD4+T淋巴细胞水平、CD4+/CD8+比值均低于正常对照儿童,差异均有统计学意义(P＜0.01)；细菌性肺炎、支原体肺炎患儿的CD8+T淋巴细胞、hs-CRP水平均高于正常对照儿童,差异均有统计学意义(P＜0.01)；病毒性肺炎患儿的CD8+T淋巴细胞、hs-CRP水平与正常对照儿童的差异均无统计学意义(P＞0.05)；细菌性肺炎患儿的PCT水平、PCT阳性率均高于支原体肺炎和病毒性肺炎患儿,差异均有统计学意义(P＜0.01)；肺炎患儿的CD4+CD25+Treg细胞水平均高于正常对照儿童,差异均有统计学意义(P＜0.01).结论 hs-CRP、PCT为儿童肺炎鉴别诊断提供了一定参考依据,PCT诊断早期细菌感染的特异性优于hs-CRP；免疫损伤在儿童肺炎中起了一定作用.