Relationship Between The Change And Severity Of Vitamin A In Children With Community Acquired Pneumonia

Background Pneumonia is one of the common diseases that threaten the health of Chinese children.Studies have shown that Vitamin A(VA),an anti-infective vitamin,can participate in the formation of lung tracheal epithelial cells and promote the differentiation and maturation of alveolar cells.Indeed,VA deficiency can induce pulmonary inflammatory response through increasing the susceptibility of infections.Interesting,the intake and metabolism of VA also undergoes serious changes during the acute phase response of inflammation.In addition,VA is also an important immune modulator,which has a profound impact on the immune function in human.However,the correlation of the immune function,acute phase response,and serum VA in children with pneumonia need to be further explored to provide a reference for their disease assessment.Objective This study analyzed and compared the levels of serum VA,interleukin-6(IL-6),lactate dehydrogenase(LDH),immunoglobulin(IgG,IgA,IgM),T lymphocyte subsets(total T lymphocytes,CD4,CD8,CD4/CD8)among children with severe community acquired pneumonia(SCAP),mild community acquired pneumonia(MCAP)and healthy children;and the correlations between VA levels and related indicators in children with SCAP,in order to provide a certain idea for the assessment of pneumonia.Methods In this study,from December 2018 to February 2020,82 patients with SCAP(severe community acquired pneumonia)who were admitted to the PICU of the First Affiliated Hospital of Xinxiang Medical College were excluded from 19 cases(5 cases of asthma,4 cases of chronic gastrointestinal disease,8 cases of congenital heart disease,2 cases of severe malnutrition),63 cases were enrolled;30 cases of MCAP in general pediatric wards,and 30 healthy children in the hospital during the same period The research subjects collected general data such as their age,gender,and weight,and all children collected venous blood immediately.The expression of serum VA was detected using liquid chromatography-tandemmass spectometry(LC-MS /MS).Levels of serum IgG,IgA and IgM were determined using immunoturbidimetry.Electrochemical luminescence was used to evaluate the level of IL-6.The level of LDH was tested by the method of enzymatic rate.The levels of serum total T lymphocytes,CD4,CD8,CD4/CD8 were detected by flow cytometry.Results There were no significant differences in gender and age among the control group,MCAP group and SCAP group.The average levels of VA in serum were 0.36 mg/L,0.25 mg/L,and 0.19 mg/L,respectively.Compared with the control group,the levels of serum VA of children with MCAP and SCAP were significantly reduced;and the levels of serum VA in the SCAP group was significantly lower than that in the MCAP group(P<0.05).According to the VA diagnostic criteria recommended by WHO,the rate of clinical/subclinical deficiency of VA in the control group,MCAP group,and SCAP group were 10.00%,36.67%,and 61.90%,respectively;and there was a significant difference in the rate of clinical/subclinical deficiency of VA in the three groups(P<0.05).The mean levels of serum IL-6 in the control group,MCAP group and SCAP group were 5.25 pg/L,18.95 pg/L and 35.68 pg/L,respectively.Compared with the control group,the content of IL-6 in children with pneumonia increased;and the content of IL-6 in the SCAP group was significantly higher than that in the MCAP group(P <0.05).Analysis of the correlation between serum VA levels and IL-6 levels in children with SCAP showed that serum VA levels in SCAP children were negatively correlated with IL-6 levels.The serum levels of LDH in children with MCAP and SCAP were significantly increased compared to those in healthy children;and the LDH level in children with SCAP was significantly higher than that in children with MCAP(P<0.05).In addition,the results also showed that there was a negative correlation between serum VA level and LDH level in children with SCAP.The serum levels of IgG,IgA and IgM in children with MCAP and SCAP were significantly decreased compared with those in healthy children;and the serum levels of IgG,IgA and IgM in children with SCAP were reduced than those in children with MCAP(P<0.05).In addition,the results also demonstrated that serum levels of VA in children with SCAP had a positive correlation with IgG,IgA,and IgM levels,respectively.The serum levels of total T lymphocytes,CD4,CD8,and CD4/CD8 in children with SCAP were 53.28%,30.26%,20.24%,and 1.59,respectively;and the serum VA level in children with SCAP was positively correlated with the levels of total T lymphocytes and CD4,not related to CD8 level.Conclusion The lower serum VA level in children with SCAP,the higher the IL-6 and LDH levels,and the lower the levels of IgG,IgA,IgM,total T cells,and CD4,suggesting that vitamin A participates in the development of pneumonia by regulating immune response The lower it is,the more serious it is.