| Objective:To investigate the expression level of soluble B7-H1(sB7-H1)in plasma of children with Mycoplasma pneumoniae pneumonia(MPP),and to analyze the correlation with Th1 Th2 Th17 cells and related factors,so as to provide new ideas for the study of MPP.Methods From January to December 2015,87 children admitted to in Children's Hospital of Soochow University and diagnosed with MPP were selected as the research objects.All the 87 children with MPP within 24h after admission were collected as the acute phase group,and the 63 children with MPP within 24h before discharge were collected as the convalescent phase group,and the 31 children with elective surgery within 24h after admission were collected as the control group,and all the clinical data were accurately recorded.The acute stage MPP was clinically classified into Severe mycoplasma pneumoniae pneumonia(SMPP)in 25 cases and non-SMPP in 62 cases.The expression levels of sB7-H1,IFN-?,IL-4,IL-17,IL-36? and GM-CSF in the serum of children with mycoplasma pneumoniae pneumonia(acute stage and recovery stage)were detected by enzyme-linked immunosorbent assay(ELISA),and the correlation was analyzed with related cytokines and clinical parameters.ROC curve was used to evaluate whether sB7-H1 and related cytokines could be used as indicators to judge the severity of mycoplasma pneumoniae pneumonia.Collection in May 2017 to October 2018 in soochow university affiliated children's hospital,line of fiberoptic bronchoscopy in children with mycoplasma pneumoniae pneumonia of alveolar lavage fluid,a total of 74 cases,and collect the same time with acute bronchial foreign body line fiber bronchoscope of 14 cases of alveolar lavage fluid,which was detected in sB7-H1,IFN-?,IL-4,IL-17,IL-36?and GM-CSF levels.Result The levels of sB7-H1?IFN-??IL-17?IL-36??GM-CSF in MPP acute plasma were significantly higher than those in the recovery period and the control group,(P<0.05),and no statistically significant difference in the recovery period compared with the control group(P>0.05).The levels of IFN-??IL-17 in MPP were higher than those in the control group(P<0.05).The plasma level of IL-4 in the acute phase of MPP was significantly lower than that in the recovery phase and the control group(P<0.05),and no statistically significant difference in the recovery period compared with the control group(P>0.05).The plasma sB7-H1 level of SMPP children was significantly higher than that of non-SMPP children,and the difference was statistically significant(P<0.05).IFN-y,IL-4,IL-17,IL-36 and GM-CS levels showed no significant difference between the two groups(P>0.05).There was a positive correlation between sB7-H1 and IL-36? in the plasma of MPP children at the acute stage(P<0.05),but no significant correlation between sB7-H1 and the expression levels of IFN-??IL-4?IL-17?GM-CSF(P>0.05).The expression level of sB7-H1 in plasma of MPP children was positively correlated with duration of fever,CRP and LDH(P<0.05).The other indicators were not correlated.sB7-H1 in plasma of MPP children with pleural effusion and duration of fever?10 days was higher than that of children without pleural effusion and with duration of fever<10 days,and the difference was statistically significant(P<0.001).The ROC of sB7-H1?IL-36??GM-CSF?IFN-??IL-17?IL-4 levels were used to determine the area under the curve of mycoplasma pneumoniae for mild and severe pneumonia(AUC)was 0.916,0.792,0.555,0.610,0.579 and 0.388.Compared with 0.5,sB7-H1 and IL-36? had statistically significant differences(P<0.01).When sB7-H1>298.971 was used as the critical value,the sensitivity and specificity of judging severe mycoplasma pneumonia were 83.9%and 71%respectively.When IL-36?>268.015 was taken as the critical value,the sensitivity and specificity of severe mycoplasma pneumonia were 88.5%and 38.7%respectively.After treatment,sB7-Hl was detected in plasma in only 40 patients,the level of sB7-H1 in the plasma of the recovered children was significantly lower than that in the acute stage(P<0.001).sB7-H1,IFN-?,IL-4,IL-17,IL-36? and GM-CSF were not detected in the alveolar lavage fluid of children with mycoplasma pneumoniae and children with bronchial foreign body.Conclusion The occurrence and development of MPP may be mainly related to the immune imbalance of Th1/Th2 mediated by sB7-H1,IFN-? and IL-4.sB7-H1 can involve with the immune response after MP infection by regulating the innate immunity,thus leading to the occurrence and development of MPP.Increased sB7-H1 and IL-36 have certain significance for clinical determination of the severity of mycoplasma pneumoniae pneumonia. |
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