支原体肺炎合并哮喘患儿血清维生素D水平与T淋巴细胞亚群及肺功能的相关性研究-现代医学

支原体肺炎合并哮喘患儿血清维生素D水平与T淋巴细胞亚群及肺功能的相关性研究

单位：1. 黄骅市人民医院儿内呼吸科, 河北黄骅 061100;
2. 黄骅市人民医院检验科, 河北黄骅 061100

分类号：R725.6

出版年·卷·期（页码）：2019·47·第六期（640-645）

摘要：

目的：探讨支原体肺炎（MPP）合并哮喘患儿血清维生素D水平与T淋巴细胞亚群及肺功能的相关性。方法：选择2015年8月至2018年6月本院收治的MPP合并哮喘患儿134例为MPP合并哮喘组，根据哮喘严重程度分级分为轻度组、中度组和重度组，另采用分层抽样的方法选择本院同期收治的未合并哮喘的MPP患儿134例为单纯MPP组，134例健康儿童为健康对照组，比较3组血清1，25-二羟维生素D₃[1，25（OH）₂D₃]、T淋巴细胞亚群水平及肺功能，分析1，25（OH）₂D₃水平与T淋巴细胞亚群及肺功能指标的相关性。结果：MPP合并哮喘组1，25（OH）₂D₃、用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、呼气峰流速（PEF）、CD3⁺、CD4⁺及CD4⁺/CD8⁺低于单纯MPP组、健康对照组，单纯MPP组低于健康对照组，差异均有统计学意义（P<0.05）；MPP合并哮喘组CD8⁺高于单纯MPP组、健康对照组，单纯MPP组高于健康对照组，差异均有统计学意义（P<0.05）。重度组血清1，25（OH）₂D₃水平及FVC、FEV1、PEF、CD3⁺、CD4⁺、CD4⁺/CD8⁺低于中度组、轻度组，中度组低于轻度组，差异均有统计学意义（P<0.05）；重度组CD8⁺高于中度组、轻度组，中度组高于轻度组，差异均有统计学意义（P<0.05）。MPP合并哮喘组1，25（OH）₂D₃水平与FVC、FEV1、PEF、CD3⁺、CD4⁺及CD4⁺/CD8⁺呈正相关（P<0.05），与CD8⁺呈负相关（P<0.05）。结论：MPP合并哮喘患儿血清1，25（OH）₂D₃水平显著降低，与T淋巴细胞亚群及肺功能指标密切相关，监测血清1，25（OH）₂D₃水平有助于MPP合并哮喘患儿的临床诊疗。

Objective:To explore the correlation between vitamin Dlevel and T lymphocyte subsets and lung function in children with Mycoplasma pneumoniae pneumonia(MPP) combined with asthma.Methods:134 cases of children with MPP combined with asthma who were admitted to our hospital from August 2015 to June 2018 were randomly selected as MPP combined with asthma group.According to the severity of asthma,asthma patients were divided into mild group, moderate group and severe group.Another 134 MPP children without asthma who were admitted to our hospital in the same period were selected as MPP group by stratified sampling.134 healthy children were selected as healthy control group.The levels of 1,25-dihydroxyvitamin D₃[1,25(OH)₂D₃],T lymphocyte subsets and lung function were compared between the three groups.The correlation between 1,25(OH)₂D₃ level and T lymphocyte subsets and lung function indexes were analyzed.Results:The levels of 1,25(OH)₂D₃,forced vital capacity (FVC),first second forced expiratory volume (FEV1),peak expiratory flow (PEF),CD3⁺,CD4⁺ and CD4⁺/CD8⁺ in MPP combined with asthma group were lower than those in MPP group and healthy control group,but those in MPP group were lower than those in healthy control group (P<0.05).The CD8⁺ in MPP combined with asthma group was higher than that in MPP group and healthy control group,that in MPP group was higher than that in healthy control group (P<0.05).The serum levels of 1,25(OH)₂D₃,FVC,FEV1,PEF,CD3⁺,CD4⁺ and CD4⁺/CD8⁺ in severe group were lower than those in moderate group and mild group,those inmoderate group was lower than those inmild group (P<0.05).The serum level of CD8⁺ in severe group was higher than that in moderate group and mild group,that in moderate group was higher than that in mild group(P<0.05).The level of 1,25(OH)₂D₃ was positively correlated with FVC,FEV1,PEF,CD3⁺,CD4⁺ and CD4⁺/CD8⁺ in MPP combined with asthma group (P<0.05),and it was negatively correlated with CD8⁺ (P<0.05).Conclusion:The serum level of 1,25(OH)₂D₃ in MPP combined with asthma children is significantly decreased,which is closely related to T lymphocyte subsets and pulmonary function.Monitoring serum 1,25(OH)₂D₃ level is helpful for clinical diagnosis and treatment of children with MPP combined with asthma.

参考文献：

[1] BIONDI E,McCULLOH R,ALVERSON B,et al.Treatment of mycoplasma pneumonia:a systematic review[J].Pediatrics,2014,133(6):1081-1090.
[2] DUENAS-MEZA E,JARAMILLO C A,CORREA E,et al.Virus and Mycoplasma pneumoniae prevalence in a selected pediatric population with acute asthma exacerbation[J].J Asthma,2016,53(3):253-260.
[3] 冯帅,陈波,李芳君,等.肺炎支原体感染与儿童哮喘的关系研究[J].安徽医药,2017,21(5):844-846.
[4] FITCH N,BECKER A B,HAYGLASS K T.Vitamin D[1,25(OH)₂D3]Differentially Regulates Human Innate Cytokine Responses to Bacterial versus Viral Pattern Recognition Receptor Stimuli[J].J Immunol,2016,196(7):2965-2972.
[5] SRIKUEA R,HIRUNSAI M.Effects of intramuscular administration of 1α,25(OH)2D3 during skeletal muscle regeneration on regenerative capacity,muscular fibrosis,and angiogenesis[J].J Appl Physiol (1985), 2016,120(12):1381-1393.
[6] 中华医学会呼吸病学分会哮喘学组.支气管哮喘防治指南(支气管哮喘的定义、诊断、治疗和管理方案)[J/OL].中华哮喘杂志(电子版),2008,2(1):3-13.
[7] 胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:1172-1173,1204-1205.
[8] 黄受方.国际肺癌研究协会/美国胸科学会/欧洲呼吸学会国际多学科肺腺癌分类(2011年版)解读[J].中华病理学杂志,2011,40(12):793-796.
[9] MEDJO B,ATANASKOVIC-MARKOVIC M,RADIC S,et al.Mycoplasma pneumoniae as a causative agent of community-acquired pneumonia in children:clinical features and laboratory diagnosis[J].Ital J Pediatr,2014,18(40):104.
[10] 常佳,刘晓红.哮喘儿童的气质类型及行为特征[J].中国临床医生杂志,2017,45(5):20-23.
[11] 魏莉,和小华,王丽.哮喘急性发作与肺炎支原体感染关系研究[J].临床肺科杂志,2014,19(3):490-492.
[12] 谭志贞,唐渊,柯桦.肺炎支原体感染对小儿支气管哮喘急性发作及免疫功能的影响[J].临床肺科杂志,2017,22(11):2112-2114.
[13] 颜海峰,霍开明,韩栋光,等.肺炎支原体感染对哮喘患儿血清IgE、白细胞介素水平及肺功能的影响[J].山东医药,2017,57(34):78-80.
[14] 潘辉,范临夏,王小军,等.血清25羟维生素D3或1,25二羟维生素D3水平与慢性阻塞性肺疾病关系的Meta分析[J].国际呼吸杂志,2016,36(12):885-892.
[15] 车向郁.支气管哮喘儿童血清25-(OH)D3、IgE、IL-17、TGF-β1水平变化及意义[J].成都医学院学报,2017,12(3):306-308.
[16] 倪莎莎,吕菊红,李雪琴,等.支原体肺炎患儿细胞免疫功能及肺功能状态变化的临床研究[J].现代生物医学进展,2016,16(25):4896-4898.
[17] 于嘉伟,袁洪新,马利林,等.CHPPC联合静脉化疗对老年胃癌患者肿瘤标志物含量及免疫功能的影响[J].东南大学学报(医学版),2017,36(3):439-443.
[18] 蒋华芳,李丽,韩文宁,等.哮喘儿童血清维生素D水平与肺功能相关性分析[J].中国儿童保健杂志,2018,26(1):109-111.
[19] 蒋文良.血清25-羟维生素D3水平与哮喘患儿免疫功能的相关性研究[J].现代医学,2014,42(7):755-758.
[20] BOVER J,EGIDO J,FERNANDEZ-GIRALDEZ E,et al.Vitamin D, vitamin D receptor and the importance of its activation in patients with chronic kidney disease[J].Nefrologia,2015;35(1):28-41.
[21] 宋志霞,郭银凤,周敏,等.活性维生素D3通过抑制TRPC6表达发挥糖尿病肾病的保护作用[J].东南大学学报(医学版),2014,33(6):683-690.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录