血清PCT、外周血补体及淋巴细胞亚群对难治性肺炎支原体肺炎患儿发生塑型性支气管炎的预测价值

doi:10.11958/20251095

天津医药 ›› 2025, Vol. 53 ›› Issue (7): 714-718.doi: 10.11958/20251095

血清PCT、外周血补体及淋巴细胞亚群对难治性肺炎支原体肺炎患儿发生塑型性支气管炎的预测价值

封金花(), 黄晗, 许丽萍, 孙爽爽, 王艳琼^△()

郑州大学附属儿童医院/河南省儿童医院郑州儿童医院呼吸科（邮编450000）

收稿日期:2025-03-18 修回日期:2025-05-06 出版日期:2025-07-15 发布日期:2025-07-21
通讯作者: ^△E-mail：woshiwangyanqiong@126.com
作者简介:封金花（1981），女，副主任医师，主要从事儿童呼吸系统疾病的诊断与治疗方面研究。E-mail：FJh0091981@163.com
基金资助:
河南省医学科技攻关计划联合共建项目(LHGJ20230588)

Predictive value of serum PCT, peripheral blood complement and lymphocyte subsets for plastic bronchitis in children with refractory Mycoplasma pneumoniae pneumonia

FENG Jinhua(), HUANG Han, XU Liping, SUN Shuangshuang, WANG Yanqiong^△()

Department of Respiratory Medicine, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450000, China

Received:2025-03-18 Revised:2025-05-06 Published:2025-07-15 Online:2025-07-21
Contact: ^△E-mail：woshiwangyanqiong@126.com

封金花, 黄晗, 许丽萍, 孙爽爽, 王艳琼. 血清PCT、外周血补体及淋巴细胞亚群对难治性肺炎支原体肺炎患儿发生塑型性支气管炎的预测价值[J]. 天津医药, 2025, 53(7): 714-718.

FENG Jinhua, HUANG Han, XU Liping, SUN Shuangshuang, WANG Yanqiong. Predictive value of serum PCT, peripheral blood complement and lymphocyte subsets for plastic bronchitis in children with refractory Mycoplasma pneumoniae pneumonia[J]. Tianjin Medical Journal, 2025, 53(7): 714-718.

摘要/Abstract

摘要：

目的探讨血清降钙素原（PCT）、外周血补体C3、C4及淋巴细胞亚群CD3⁺、CD4⁺、CD8⁺细胞在难治性肺炎支原体肺炎（RMPP）患儿并发塑型性支气管炎（PB）中的预测价值。方法选取222例RMPP患儿，根据是否并发PB分为PB组（51例）和非PB组（171例）。采用荧光免疫定量仪检测患儿入院时血清PCT水平，采用免疫比浊法检测补体C3、C4水平，采用流式细胞仪检测CD3⁺、CD4⁺、CD8⁺T淋巴细胞比例。多因素Logistic回归分析RMPP患儿发生PB的影响因素；绘制受试者工作特征（ROC）曲线分析指标的预测价值。结果 PB组PCT、CD8⁺T细胞比例高于非PB组，发热时间长于非PB组，补体C3、CD4⁺T细胞比例低于非PB组（P<0.05）。PCT、CD8⁺T细胞比例升高是RMPP患儿发生PB的危险因素，补体C3、CD4⁺T细胞比例升高是保护因素（P<0.05）。PCT、补体C3、CD4⁺T细胞比例、CD8⁺T细胞比例单独预测PB的曲线下面积（AUC）分别为0.763、0.802、0.788、0.802，联合预测的AUC为0.915，单独预测AUC均低于联合AUC（Z分别为3.199、2.825、3.112、2.514，P<0.05）。结论 PCT、补体C3、CD4⁺T、CD8⁺T细胞水平是RMPP患儿并发PB的影响因素，其联合检测有利于早期预测PB的发生。

关键词: 肺炎, 支原体, 降钙素原, 补体C3, 补体C4, 淋巴细胞亚群, 塑型性支气管炎

Abstract:

Objective To explore the predictive value of serum procalcitonin (PCT), peripheral blood complement C3, C4 and lymphocyte subsets CD3⁺, CD4⁺ and CD8⁺ cells for plastic bronchitis (PB) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods A total of 222 children with RMPP were selected and divided into the PB group (51 cases) and the non-PB group (171 cases) based on whether they were complicated with PB. The serum PCT level of the children at admission was detected by fluorescence immunoquantitative analyzer, and levels of complement C3 and C4 were detected by immunoturbidimetry. The proportions of CD3⁺, CD4⁺ and CD8⁺T lymphocytes were detected by flow cytometry. Multivariate Logistic regression analysis was conducted to analyze influencing factors of PB in children with RMPP. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of the indicators. Results The levels of PCT and CD8⁺T cells and the duration of fever were higher in the PB group than those in the non-PB group, while the levels of complement C3 and CD4⁺T cells were lower than those in the non-PB group (P<0.05). Elevated levels of PCT and CD8⁺T cells were risk factors for the occurrence of PB in children with RMPP, while elevated levels of complement C3 and CD4⁺T cells were protective factors for the occurrence of PB in children with RMPP (P<0.05). The AUCs of PCT, complement C3, the proportion of CD4⁺T cells and the proportion of CD8⁺T cells predicted separately were 0.763, 0.802, 0.788 and 0.802 respectively, and the AUC of combined prediction was 0.915. The AUCs of individual predictions were all lower than those of the combined AUC (Z=3.199, 2.825, 3.112 and 2.514, P<0.05). Conclusion PCT, complement C3, CD4⁺ T cell ratio, and CD8⁺ T cell ratio are influencing factors for the occurrence of PB in children with RMPP, and their combined detection is beneficial for the early prediction of PB.

Key words: pneumonia, Mycoplasma, procalcitonin, complement C3, complement C4, lymphocyte subsets, plastic bronchitis

中图分类号:

R725

图/表 5

参考文献 25

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组别			n	发热			热峰/℃			发热时间/d
非PB组			171	170（99.42）			39.49±0.53			7.25±1.76
PB组			51	51（100.00）			39.62±0.41			10.48±2.20
P或t				1.000^▲			1.613			10.831^＊＊
组别	咳嗽				气喘			胸腔积液			CRP/（mg/L）
非PB组	168（98.25）				55（32.16）			39（22.81）			75.92±15.86
PB组	50（98.04）				20（39.22）			17（33.33）			80.14±16.28
P、χ²或t	1.000^▲				0.873			2.308			1.658
组别		WBC/（×10⁹/L）				NEU百分比/%			LDH/（U/L）
非PB组		9.45±1.82				67.89±13.09			382.66±89.12
PB组		9.86±1.95				71.45±13.81			410.01±90.14
t		1.389				1.683			1.918

组别			n	发热			热峰/℃			发热时间/d
非PB组			171	170（99.42）			39.49±0.53			7.25±1.76
PB组			51	51（100.00）			39.62±0.41			10.48±2.20
P或t				1.000^▲			1.613			10.831^＊＊
组别	咳嗽				气喘			胸腔积液			CRP/（mg/L）
非PB组	168（98.25）				55（32.16）			39（22.81）			75.92±15.86
PB组	50（98.04）				20（39.22）			17（33.33）			80.14±16.28
P、χ²或t	1.000^▲				0.873			2.308			1.658
组别		WBC/（×10⁹/L）				NEU百分比/%			LDH/（U/L）
非PB组		9.45±1.82				67.89±13.09			382.66±89.12
PB组		9.86±1.95				71.45±13.81			410.01±90.14
t		1.389				1.683			1.918

组别		n	PCT/（μg/L）		补体C3/（g/L）		补体C4/（g/L）
非PB组		171	4.07±1.15		0.79±0.18		0.20±0.07
PB组		51	5.60±1.67		0.58±0.15		0.18±0.04
t			7.452^＊＊		7.580^＊＊		1.946
组别	CD3⁺/%			CD4⁺/%		CD8⁺/%
非PB组	65.76±11.81			48.17±8.90		24.12±4.87
PB组	62.52±10.50			37.70±7.46		30.47±5.16
χ²或t	1.762			7.636^＊＊		8.061^＊＊

组别		n	PCT/（μg/L）		补体C3/（g/L）		补体C4/（g/L）
非PB组		171	4.07±1.15		0.79±0.18		0.20±0.07
PB组		51	5.60±1.67		0.58±0.15		0.18±0.04
t			7.452^＊＊		7.580^＊＊		1.946
组别	CD3⁺/%			CD4⁺/%		CD8⁺/%
非PB组	65.76±11.81			48.17±8.90		24.12±4.87
PB组	62.52±10.50			37.70±7.46		30.47±5.16
χ²或t	1.762			7.636^＊＊		8.061^＊＊

变量	β	SE	Wald χ²	P	OR	OR 95%CI
PCT	1.011	0.312	10.505	0.001	2.749	1.491~5.067
补体C3	-0.247	0.067	13.611	<0.001	0.781	0.685~0.891
CD4⁺T细胞	-0.282	0.081	12.152	<0.001	0.754	0.643~0.884
CD8⁺T细胞	1.065	0.335	10.114	0.001	2.902	1.505~5.596
发热时间	0.100	0.109	0.839	0.360	1.105	0.892~1.368
常数项	32.973	6.345	27.006	<0.001	0.000

血清PCT、外周血补体及淋巴细胞亚群对难治性肺炎支原体肺炎患儿发生塑型性支气管炎的预测价值

Predictive value of serum PCT, peripheral blood complement and lymphocyte subsets for plastic bronchitis in children with refractory Mycoplasma pneumoniae pneumonia

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变量	AUC	95%CI	截断值	敏感度/%	特异度/%
PCT	0.763	0.683~0.843	4.68 μg/L	76.56	66.72
补体C3	0.802	0.739~0.866	0.70 g/L	80.47	69.65
CD4⁺T细胞	0.788	0.724~0.852	42.92%	80.43	70.82
CD8⁺T细胞	0.802	0.728~0.877	27.50%	76.52	75.49
联合	0.915	0.867~0.963	-	90.25	80.79

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