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

doi:10.11958/20251095

Abstract

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

CLC Number:

R725

Figures/Tables 5

References 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