Clinical Study Of Refractory Mycoplasma Pneumoniae Pneumonia On Immunity And Inflammation In Children

Objective:The purpose of this study was to explore the variety of immunity and inflammation in refractory mycoplasma pneumoniae pneumonia as well as its correlation with the severity of this disease, and provide clinical data to help make better management strategies. Background and Methods:Till now, the majority of studies on RMPP nationwide focused mainly on the analysis of specific cytokine, not including a systematic analysis of immunity, multi-cytokines, or their correlation with the severity of the disease, which uses the plain MPP as the control group. Since June 2014 to February 2016, we consecutively recruited 40 children diagnosed with RMPP(experimental group) and 46 children diagnosed with non-refractory MPP(control group) in acute phase from the department of respiratory medicine of our hospital. The measurement of CD4+T cell, CD8+T cell, NK cell, the ratio of CD4+/CD8+, the immunoglobulin titres(Ig A?Ig M?Ig G?Ig E), and the titres of IL-2?IL-6?IL-8?IL-10?CRP?LDH in acute phase were carried out for all included patients. Statistical analysis was performed using SSPS17.0. All data was performed using homogeneity of variance and normal distribution test before analyzing, and expressed as mean value±standard deviation. The comparison of the mean value between two groups was performed using independent sample t-test. Counting data was represented with percentage to judge the correlation between each measured value and the severity of the disease. P<0.05 was considered statistically significant. Results:Among the 46 non-refractory MPP patients, 25 were male, and 21 were female, the mean age of this group was 5.21±1.64 years. Among the 40 RMPP patients, 12 were male, and 28 were female, the mean age of this group was 7.19±1.85 years. There was significant difference in gender( T(X2) value =5.174,P<0.05), the proportion of female patients in RMPP group increased significantly. The mean age of non-refractory MPP group was much younger than that of RMPP group, there was significant difference in ages between these two groups( T(X2) value =5.174,P<0.05), which indicated that RMPP was more prevalent in school-age children.7 patients( 15.2%) in non-refractory MPP group showed CRP>40mg·L-1, and 21 patients( 52.5%) in RMPP group showed CRP>40mg·L-1, there was significant difference in CRP titres between these two groups( X2 value =13.544,P<0.05).18 patients( 39.1%) in non-refractory MPP group showed LDH>302IU·L-1, whereas 23 patients( 57.5%) in RMPP group showed LDH>302IU·L-1, there was no difference in LDH titres between these two groups( X2 value =2.894,P?0.05). Compared with non-refractory MPP group, the Ig A and Ig G titres in RMPP group differs not significantly. The Ig M and Ig E titres were significantly higher in RMPP group than those in non-refractory MPP Group( P<0.05).All cytokine titres increased in both groups variously, there was no difference in the IL-2 and IL-10 titres between non-refractory MPP group and RMPP group( P=0.197 for IL-2, and P=0.110 for IL-10). Compared with non-refractory MPP group, the IL-8 and IL-6 titres increased significantly in RMPP group( P<0.05).With respect to CD cells line detection, there was no difference in CD8+ between these two groups( t value =0.438,P=0.662), whereas CD4+ decreased significantly in RMPP group than that in MPP group( t value =5.932,P<0.05). And the ratio of CD4+/CD8+ decreased significantly in RMPP group than that in non-refractory MPP group( t value =7.766,P<0.05). NK cells decrease decreased significantly in RMPP group than that in non-refractory MPP group(t value = 5.935, P <0.05). Conclusions:1. RMPP is more prevalent in female school-age children.2. The Ig M and Ig E titres increase significantly in RMPP group than those in MPP group in acute phase.3. The IL-6 and IL-8 titres increase significantly in RMPP during the early stage.4. NK cell?CD4+T cell value and the ratio of CD4+/CD8+ showed significant changes in RMPP.5. CRP is greater than 40mg·L-1 is one of the risk factors of RMPP, but the acute phase LDH mild disease group and the treatment group had no statistical significance.6. Systematic analysis of the indicators of immunity and inflammation can help to identify RMPP during the early stage.