免疫指标检测在小儿难治性支原体肺炎中的临床意义

摘要

目的 探讨研究小儿难治性支原体肺炎细胞免疫和体液免疫指标检测结果,并分析其临床意义.方法 将42例难治性支原体肺炎和46例普通支原体肺炎患儿分别记为试验A组和试验B组,另选取50例同年龄段健康志愿者记为对照组.分别采用流式细胞术、微量免疫比浊法对3组细胞免疫指标(CD3+、CD4+、CD8+、CD19+、CD4+/CD8+及CD16+CD56+)、体液免疫指标(IgA、IgG、IgM)进行检测.试验组A组和试验B组所有患儿均给予对症支持治疗,比较两组治疗前后及对照组细胞和体液免疫指标水平变化.将试验A组患儿依据预后效果分为2个亚组,对比其免疫指标水平.结果 治疗前试验A组和试验B组CD8+、CD19+、IgA、IgG及IgM水平均高于对照组,差异有统计学意义(P<0.05),而CD3+、CD4+、CD4+/CD8+、CD16+CD56+水平均低于对照组,差异有统计学意义(P<0.05);试验A组和试验B组间以上各项指标差异有统计学意义(P<0.05);试验A组和试验B组治疗后CD8+、CD19+、IgA、IgG及IgM水平均较治疗前显著降低,差异有统计学意义(P<0.05);CD3+、CD4+、CD4+/CD8+、CD16+CD56+水平均较治疗前显著升高,差异有统计学意义(P<0.05),且试验A组和试验B组间以上各项指标差异有统计学意义(P<0.05);试验A组共有34例预后良好,预后良好率为80.95%;预后良好组CD3+、CD4+、CD4+/CD8+、CD16+CD56+水平均远远高于预后不良组,差异有统计学意义(P<0.05),且CD8+、CD19+、IgA、IgG及IgM水平均远远低于预后不良组(P<0.05).结论 小儿难治性支原体肺炎细胞免疫和体液免疫水平均发生明显异常,可为指导治疗和预后评估提供参照.%Objective To discuss and study on the detection results of immune indexes in children with refractory Mycoplasma pneumonia,and to analyze their significance.Methods Forty-two cases of children with refractory Mycoplasma pneumonia and 46 cases of children with common Mycoplasma pneumonia were respectively noted as the experimental A group and experimental B group,and another 50 cases of healthy volunteers with the same age segment were noted as the control group.The indicators of immune cells (including CD3+,CD4+,CD8+,CD19+,CD4+/CD8+ and CD16+CD56+) and indicators of humoral immunity (including IgA,IgG and IgM) in the three groups were respectively detected by flow cytometry and micro immunoassay.All of the children in the experimental A group and experimental B group were given symptomatic supportive treatment,and the changes of cellular and humoral immune index in the two groups before and after treatment and control group were compared.The children in the experimental A group were divided into two sub-groups according to the prognosis effect,between which the levels of immune indexes were compared.Results The levels of CD8+,CD19+,IgA,IgG and IgM in the experimental A group and experimental B group before treatment were significantly higher than those in the control group (P<0.05),while the levels of CD3+,CD4+,CD4+/CD8+ and CD16+CD56+ were significantly lower than those in the control group (P<0.05),and there were significant differences between the experimental A group and the experimental B group (P<0.05).The levels of CD8+,CD19+,IgA,IgG and IgM in the experimental A group and experimental B group after treatment were significantly decreased compared with those before treatment (P<0.05),while the levels of CD3+,CD4+,CD4+/CD8+,CD16+CD56+ were significantly decreased (P<0.05),and there were significant differences between the experimental A group and the experimental B group (P<0.05).There were 34 cases of good prognosis in the experimental A group,of which the rate was 80.95%.The levels of CD3+,CD4+,CD4+/CD8+ and CD16+CD56+ in the good prognosis group were significantly higher than those in the poor prognosis group (P<0.05),while the levels of CD8+,CD19+,IgA,IgG and IgM were significantly lower than those in the poor prognosis group (P<0.05).Conclusion The levels of cellular immunity and humoral immunity indexes in children with refractory Mycoplasma pneumonia are obviously abnormal,which can provide reference for guiding treatment and prognosis evaluation.