牛波 池跃朋 帅金凤 杨会荣 黄坤玲 曹丽洁 刘建华

[摘要] 目的 探討儿童难治性支原体肺炎的免疫功能变化。 方法 选择2014年1月～2015年5月在河北省儿童医院治疗的难治性支原体肺炎患儿47例（难治性组）、普通支原体肺炎患儿50例（普通组）以及健康体检儿童50例（对照组）为研究对象。采用流式细胞仪以及免疫透射比浊法检测所有研究对象T淋巴细胞亚群以及外周血免疫球蛋白水平，分析儿童难治性肺炎支原体肺炎的免疫机制。 结果 难治性组患儿血清IgG、IgM、CD8+、CD19+均显著高于对照组，CD3+、CD4+、CD4+/CD8+、CD16+、CD56+均显著低于对照组，差异均有高度统计学意义（P < 0.01）；普通组患儿血清IgG、IgM、CD8+、CD19+均显著高于对照组，CD4+、CD4+/CD8+均显著低于对照组，差异均有统计学意义（P < 0.05或P < 0.01）；难治性组患儿血清CD3+、CD4+/CD8+、CD16+ CD56+均显著低于普通组患儿，CD19+显著高于普通组患儿，差异均有高度统计学意义（P < 0.01）。难治性组患儿经治疗后2个月复查，血清IgG、IgA、IgM、CD3+、CD4+、CD8+、CD4+/CD8+、CD19+、CD16+ CD56+水平与治疗前比较差异无统计学意义（P > 0.05）。 结论 体液免疫及细胞免疫均参与了儿童难治性肺炎支原体肺炎的发病，患儿存在免疫功能紊乱，并且持续时间较长。

[关键词] 儿童难治性肺炎支原体肺炎；免疫机制；T淋巴细胞亚群；外周血免疫球蛋白

[中图分类号] R725.6 [文献标识码] A [文章编号] 1673-7210（2016）02（c）-0107-04

Discussion of immune mechanism of children refractory mycoplasma pneumoniae pneumonia

NIU Bo1 CHI Yuepeng2 SHUAI Jinfeng1 YANG Huirong1 HUANG Kunling1 CAO Lijie1 LIU Jianhua1

1.The Second Ward of Department of Respiration， Children's Hospital of Hebei Province， Hebei Province， Shijiazhuang 050031， China； 2. Department of Tuberculosis， the Chest Hospital of Hebei Province， Hebei Province， Shijiazhuang 050041， China

[Abstract] Objective To discuss the immune mechanism of children refractory mycoplasma pneumoniae pneumonia （RMPP）. Methods From Jan 2014 to May 2015， 47 cases with RMPP （RMPP group）， 50 cases with MPP （MPP group） and 50 healthy children （control group） in Children's Hospital of Hebei Province were selected as study subjects. Peripheral blood T lymphocyte subsets and immunoglobulin levels were detected with flow cytometry and immune turbidimetry， and the immune mechanism of children refractory mycoplasma pneumoniae pneumonia was analyzed. Results Serum levels of IgG， IgM， CD8+， CD19+ of the RMPP group were higher than those of the control group， and serum levels of CD3+， CD4+， CD4+/CD8+， CD16+ CD56+ were lower than those of the control group， the differences were statistically significant （P < 0.01）； serum levels of IgG， IgM， CD8+， CD19+ of the MPP group were higher than those of the control group， and CD4+， CD4+/CD8+ were lower than control group， the differences were statistically significant （P < 0.05 or P < 0.01）； serum levels of CD3+， CD4+/CD8+， CD16+ CD56+ of the RMPP group were lower than those of the MPP group， and CD19+ was higher than that of the MPP group， the differences were statistically significant （P < 0.01）. Two months after treatment， serum levels of IgG， IgA， IgM， CD3+， CD4+， CD8+， CD4+/CD8+， CD19+， CD16+ CD56+ of the RMPP group showed no difference with those before treatment （P > 0.05）. Conclusion Both humoral immunity and cell-mediated immunity are involved in the pathogenesis of RMPP. Children with RMPP combine with the presence of immune dysfunction， and long duration.

[Key words] Refractory mycoplasma pneumoniae pneumonia； Immune mechanism； T-lymphocyte subsets； Peripheral immunoglobulin

肺炎是儿童的高发病，而肺炎支原体是导致儿童肺炎的常见病原体，大环内酯类抗生素是治疗肺炎支原体的常规药物，但是临床上有部分患儿虽然经过大环内酯类药物正规治疗，但效果较差，甚至危及患儿生命，称为难治性肺炎支原体肺炎。难治性肺炎支原体肺炎与感染后机体产生严重免疫应答反应有密切的关系，但确切的发病机制还不十分明确[1-2]。本研究对河北省儿童医院（以下简称“我院”）治疗的难治性肺炎支原体肺炎患儿的临床资料进行分析，探讨难治性肺炎支原体肺炎患儿的免疫机制。……