目的:探讨肺炎支原体肺炎(MPP)患儿支气管肺泡灌洗液(BALF)中氧化应激与重症MPP(SMPP)和难治性MPP(RMPP)临床特征的相关性。
方法:收集83例MPP患者的临床和BALF相关数据,其中29例患有SMPP,54例患有一般MPP(GMPP);RMPP组37例,非RMPP组46例.检测BALF中丙二醛(MDA)和高级氧化蛋白产物(AOPP)的水平以及超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-PX)的活性水平。对MDA、AOPP,SOD,GSH-PX,性别,热峰值,中性粒细胞百分比,C反应蛋白,乳酸脱氢酶,D-二聚体,肺巩固,痰栓子,和胸腔积液.
结果:MPP组BALF中MDA和AOPP水平明显高于对照组(p<0.05),而SOD和GSH-PX水平低于对照组(p<0.05)。RMPP组BALFAOPP水平高于非RMPP组,BALF中SOD和GSH-PX水平低于非RMPP组,差异有统计学意义(p<0.05)。SMPP组患儿BALF中MDA和AOPP水平高于GMPP组,SOD和GSH-PX水平低于GMPP组,差异有统计学意义(p<0.05)。Logistic回归模型的C指数为0.960(95%置信区间0.958-0.963),表明该模型具有良好的预测能力。
结论:高级氧化蛋白产物可能是预测SMPP和RMPP状况的标志物,预测模型可以评估儿童进展为RMPP的风险,有利于临床诊断和治疗。
OBJECTIVE: To investigate the correlation between oxidative stress in the bronchoalveolar lavage fluid (BALF) of children with Mycoplasma pneumoniae pneumonia (MPP) and the clinical characteristics of severe MPP (SMPP) and refractory MPP (RMPP).
METHODS: Clinical and BALF-related data were collected from 83 patients with MPP, of which 29 had SMPP and 54 had general MPP (GMPP); 37 patients were in the RMPP group and 46 in the non-RMPP group. The levels of malondialdehyde (MDA) and advanced oxidation protein products (AOPP) as well as the activity levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) in BALF were detected. Logistic regression analyses were performed on MDA, AOPP, SOD, GSH-PX, gender, heat peak, neutrophil percentage, C-reactive protein, lactate dehydrogenase, d-dimer, lung consolidation, sputum embolus, and pleural effusion.
RESULTS: The levels of MDA and AOPP in the BALF of the MPP group were significantly higher than those in the control group (p < .05), whereas SOD and GSH-PX levels were lower than those in the control group (p < .05). The BALF AOPP levels in the RMPP group were higher than those in the non-RMPP group, and the SOD and GSH-PX levels in the BALF were lower than those in the non-RMPP group; the difference was statistically significant (p < .05). The levels of MDA and AOPP in the BALF of children in the SMPP group were higher than those in the GMPP group, and the levels of SOD and GSH-PX were lower than those in the GMPP group, with statistically significant differences (p < .05). The C-index of the logistic regression model was 0.960 (95% confidence interval 0.958-0.963), which indicates that the model has good predictive ability.
CONCLUSIONS: Advanced oxidation protein products may be a marker for predicting the conditions of SMPP and RMPP, and the prediction model can assess the risk of progression in children to RMPP, which is conducive to clinical diagnosis and treatment.