高分辨率CT特征、炎症水平与肺炎支原体肺炎患儿急性期诱导痰病原菌负荷的关系

doi:10.20274/j.cnki.issn.1674-3865.2026.01.016

摘要/Abstract

摘要：

目的探究肺炎支原体肺炎患儿急性期高分辨率CT（HRCT）特征、血清炎症水平与诱导痰中病原菌负荷的相关性。方法本研究共纳入2020年3月至2023年3月在平顶山市中医医院接受治疗的肺炎支原体肺炎患儿100例，所有患儿均接受HRCT检查，并对其诱导痰中肺炎支原体DNA拷贝量进行测定，并据此进行分组。低负荷组42例（肺炎支原体DNA拷贝量≤10⁶/mL），高负荷组58例（肺炎支原体DNA拷贝量>10⁶/mL）。比较组间患儿的HRCT特征及血清炎症因子水平变化、相关Th1/Th2转录因子，并探究各指标与患者病原菌负荷的相关性。结果高负荷组支气管充气征、肺实变影、大叶性实变影发生率高于低负荷组，差异有统计学意义（P<0.05）。高负荷组患儿可溶性髓细胞触发体-1(sTREM-1)、可溶性细胞间黏附分子-1(sICAM-1)水平高于低负荷组，人β-防御素-1（hBD-1）水平低于低负荷组，差异有统计学意义（P<0.05）；两组间hBD-2水平比较差异无统计学意义（P>0.05）。高负荷组患儿的T细胞分化箱蛋白（T-bet） mRNA、GATA转录因子3（GATA3） mRNA表达高于低负荷组，细胞因子信号抑制蛋白1（SOCS1） mRNA、SOCS3 mRNA表达低于低负荷组，差异有统计学意义（P<0.05）。点二列相关分析结果显示，支气管充气征（r=0.697）、肺实变影（r=0.544）、大叶性实变影（r=0.631）均与病原菌负荷呈正相关（P<0.05）。Pearson相关性分析显示，sTREM-1、sICAM-1、T-bet mRNA、GATA3 mRNA与其病原菌负荷呈正相关（r=0.651，0.654，0.647，0.654，P<0.001），hBD-1、SOCS1 mRNA、SOCS3 mRNA与其病原菌负荷呈负相关（r=-0.452，-0.655，-0.656，P<0.001）。Logistic回归分析可知支气管充气征、大叶性实变影及高sTREM-1是病原菌高负荷的独立危险因素。结论肺炎支原体肺炎患儿急性期的HRCT分型与支原体负荷显著相关，且与sTREM?1、sICAM?1及Th1/Th2转录因子表达密切关联，可为病情评估与个体化治疗提供辅助依据。

关键词: 肺炎支原体肺炎, 急性期, 高分辨率CT, 炎症因子, 病原菌负荷

Abstract:

Objective To investigate the relationship of high-resolution computed tomography(HRCT) features and serum inflammatory levels with the pathogen load in induced sputum of children with Mycoplasma pneumoniae pneumonia（MPP） during the acute phase. Methods One hundred children diagnosed with MPP who were treated at our hospital from March 2020 to March 2023 were enrolled in the study. All subjects underwent HRCT and quantitative measurement of Mycoplasma pneumoniae DNA copy number in induced sputum. Based on a threshold of 10⁶ copies/mL, patients were assigned to a low-load group(≤10⁶ copies/mL; n=42) or a high-load group(>10⁶ copies/mL; n=58). HRCT features, serum levels of inflammatory factors and related Th1/Th2 transcription factors were compared between groups, and the relationship between each indicator and the pathogen load was explored. Results Compared with the low-load group, the high-load group showed significantly higher incidence of air bronchogram, pulmonary consolidation, and lobar consolidation on HRCT(all P<0.05). The levels of serum sTREM?1 and sICAM?1 were higher in the high-load group than in the low-load group, while hBD?1 was lower(P<0.05); hBD?2 level did not differ between the two groups(P>0.05). The expressions of T-bet mRNA and GATA3 mRNA were higher in the high-load group than in the low-load group, while the expressions of SOCS1 mRNA and SOCS3 mRNA were lower, the differences being statistically significant(P<0.05). Point-biserial correlation analysis showed that air bronchogram（r=0.697）, pulmonary consolidation（r=0.544）, and lobar consolidation（r=0.631） were positively correlated with pathogen load(P<0.05). Pearson correlation analysis revealed that sTREM-1, sICAM-1, T-bet mRNA, and GATA3 mRNA were positively correlated with pathogen load（r=0.651，0.654，0.647，0.654，P<0.001）, whereas hBD-1, SOCS1 mRNA, and SOCS3 mRNA were negatively correlated（r=-0.452，-0.655，-0.656，P<0.001）. Logistic regression analysis indicated that air bronchogram, lobar consolidation, and elevated sTREM-1 were independent risk factors for high pathogen load. Conclusion During acute phase of MPP, specific HRCT phenotypes are significantly associated with Mycoplasma pneumoniae pathogen load, and are closely related to the expressions of sTREM?1, sICAM?1 and Th1/Th2 transcription factors, which may provide auxiliary evidence for disease severity assessment and individualized management.

Key words: Mycoplasma pneumoniae pneumonia, Acute phase, High-resolution CT, Inflammatory factors, Pathogen load

中图分类号:

R725.6

杜琳琳, 李君, 徐灿灿. 高分辨率CT特征、炎症水平与肺炎支原体肺炎患儿急性期诱导痰病原菌负荷的关系[J]. 中国中西医结合儿科学, 2026, 18(1): 82-87.

Linlin DU, Jun LI, Cancan XU. Correlation of high‐resolution CT features and serum inflammatory levels with induced-sputum pathogen load in children with Mycoplasma pneumoniae pneumonia during acute phase[J]. Chinese Pediatrics of Integrated Traditional and Western Medicine, 2026, 18(1): 82-87.

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组别	n	支气管壁增厚		淋巴结肿大		支气管充气征		胸腔积液
组别	n	是	否	是	否	是	否	是	否
低负荷组	42	30(71.43)	12(28.57)	18(42.86)	24(57.14)	15(35.71)	27(64.29)	5(11.90)	37(88.10)
高负荷组	58	50(86.21)	8(13.79)	22(37.93)	36(62.07)	40(68.97)	18(31.03)	15(25.86)	43(74.14)
χ²值		3.325		0.246		10.882		2.966
P值		0.068		0.620		0.001		0.085
组别	n	肺实变影		小叶性实变影		节段性实变影		大叶性实变影
组别	n	是	否	是	否	是	否	是	否
低负荷组	42	28(66.67)	14(33.33)	20(47.62)	22(52.38)	18(42.86)	24(57.14)	8(19.05)	34(80.95)
高负荷组	58	53(91.38)	5(8.62)	25(43.10)	33(56.90)	30(51.72)	28(48.28)	25(43.10)	33(56.90)
χ²值		9.667		0.201		0.767		6.376
P值		0.002		0.654		0.381		0.012

组别	n	sTREM-1（μg/L）	sICAM-1（μg/L）	hBD-1（mg/L）	hBD-2（mg/L）
低负荷组	42	1.72±0.23	243.21±31.12	14.22±1.23	51.02±6.12
高负荷组	58	2.33±0.34	399.15±34.11	13.02±1.02	53.98±4.12
t值		-10.071	-23.399	5.323	-1.914
P值		<0.001	<0.001	<0.001	0.059

组别	n	T-betmRNA	GATA3mRNA	SOCS1mRNA	SOCS3mRNA
低负荷组	42	1.38±0.15	1.97±0.23	0.66±0.06	0.82±0.09
高负荷组	58	1.88±0.12	3.23±0.35	0.26±0.05	0.46±0.06
t值		-18.503	-20.351	36.286	23.996
P值		<0.001	<0.001	<0.001	<0.001

因素	Β值	SE值	OR值（95%CI）	P值
支气管充气征	1.050	0.420	2.858（1.255～6.509）	0.012
大叶性实变影	0.920	0.380	2.509（1.191～5.285）	0.015
肺实变影	0.620	0.360	1.859（0.918～3.764）	0.085
sTREM-1	0.980	0.290	2.664（1.509～4.704）	0.001
年龄	0.080	0.070	1.083（0.944～1.243）	0.253