| Objective:Analyze the clinical data of children with different severity of MPP and provide clinical basis for early identification of SMPP;By measuring the relative expression levels of Th17-related cytokine IL-17 and its transcription factor ROR?t,Treg-related cytokine TGF-?1 and its transcription factor Foxp3 in BALF of children with different degrees of MPP,to clarify the changes of Th17/Treg expression in BALF of children with MPP,and further explore the relationship between Th17/Treg imbalance and the severity of MPP in children.Methods:We enrolled clinical diagnosed MPP patients who were treated with bronchoscopy in Pediatric Respiratory Department of the First Hospital of Jilin University during 2016 October to 2017 August as the research object.According to the severity of MPP,22 cases were divided into severe group and 35 cases were mild group.We analyzed the clinical information of these 2 groups.20 patients with airway foreign body at the same time were selected as control group.The relative expression levels of IL-17,TGF-?1,ROR?t,and Foxp3 in BALF of the 2 groups of children with MPP and control group were detected by qPCR,and the ratios of IL-17/TGF-?1 and ROR?t/Foxp3 were calculated.The results were statistically analyzed using SPSS22.0and Graphpad 7.0 software.Results:1.Clinical features of MPP children in severe group and mild group were analyzed:Single factor analysis results showed that the proportion of fever peak?40.0??40.91%vs 17.14%,P<0.05?,the proportion of febrile time?10 days?50%vs 11.43%,P<0.05?,the proportion of pleural effusion?36.36%vs 8.57%,P<0.05?,the proportion of extrapulmonary complications?45.45%vs 17.14%,P<0.05?,the CRP[41.40?21.60,65.53?vs 11.44?6.20,17.97?,P<0.05],the LDH?488.50±98.80 vs.331.60±84.84,P<0.05?,and the proportion of airway obstruction by secretions?45.45%vs 11.43%,P<0.05?were higher in the severe group compared with the mild group.The multiple logistic regression analysis showed that,the CRP and LDH were independent predictors of the SMPP?OR=1.179,1.021,P<0.05?.2.Comparison of IL-17 and TGF-?1 levels in BALF of MPP children and control group:The relative expression of IL-17 in the severe group was significantly lower than that in the mild group and control group?P<0.0001?.There was no statistically significant difference of IL-17 levels between the mild group and control group.No significant differences in TGF-?1 levels among groups.The IL-17/TGF-?1 ratio in the severe group was significantly lower than in the mild group?P=0.0008?and control group?P=0.0003?.3.In the BALF of the severe group,the ROC curve analysis showed that the cut-off values of the IL-17 was 6.8×10-4,the sensitivity was 1,the specificity was 0.6,the AUC was 0.8143,and the P<0.0001.4.Comparison of ROR?t and Foxp3 levels in BALF of MPP children and control group:The relative expression of ROR?t in the severe group was significantly lower than that in the mild group and control group?P<0.0001?.There was no statistically significant difference of ROR?t levels between the mild group and control group.No significant differences in Foxp3 levels among groups.The ROR?t/Foxp3 ratio in the severe group was significantly lower than in the mild group?P=0.0004?and control group?P=0.0001?.5.Correlation analysis showed that there was a significant positive correlationbetween IL-17 and ROR?t levels?r=0.6788,P<0.0001?,and there was a significant positive correlation between TGF-?1 and Foxp3 levels?r=0.5253,P<0.0001?in BALF.Conclusion:1.Compared with mild MPP,SMPP had a longer febrile time,higher fever peak,the proportions of pleural effusion and extrapulmonary complications were high,CRP and LDH were higher,and the proportion of airway obstruction by secretions was higher.CRP and LDH increase were independent risk factors of SMPP.2.The IL-17 level in BALF of the severe group was significantly lower than that in the mild group and control group.Detection of IL-17<6.8×10-44 in BALF by qPCR method can be used as an early predictor of SMPP in children.3.There was an imbalance of Th17/Treg in children with severe MPP,which manifested as a decrease in Th17 in BALF.This provides a laboratory basis for the clinical application of immunomodulatory agents for the treatment of SMPP. |
PDF Full Text Request