| Objective:By analyzing the level of CD19+,CD4+,CD8+,CD3+HLA-DR+and vitamin A in children with severe or refractory mycoplasma pneumoniae pneumonia,and general mycoplasma pneumoniae pneumonia,we are to explore the changes of the level of lymphocyte subsets and VitA and risk factors in children with severe or refractory mycoplasma pneumoniae pneumonia,thus to provide theoretical basis for clinical early warning and treatment of severe or refractory cases.Methods:Using the method of retrospective analysis,we chose 17 cases of severe or refractory mycoplasma pneumoniae pneumonia,54 cases of general mycoplasma pneumoniae pneumonia and 23 cases of upper respiratory tract infection or non-infectious children who were chosen to be the control group as objects of study who were diagnosed in the department of pediatrics of the Second Affiliated Hospital of Kunming Medical University from January 2017 to December 2018.In the morning of the next day after admission,all patients are needed to check for lymphocyte subsets such as CD 19+,CD4+,CD8+,CD3+HLA-DR+and vitaminA.CD19+,CD4+,CD8+,CD3+HLA-DR+were determined by flow cytometry and vitamin A was detected by high performance liquid chromatography(HPLC).The changes of CD19+,CD4+,CD8+,CD3+HLA-DR+and vitamin A levels among the three groups and the risk factors of severe or refractory mycoplasma pneumoniae pneumonia were studied.All datas were analyzed by SPSS19.0.The measurement datas were tested by normal distribution test and homogeneity of variance test.The measurement datas of normal distribution were expressed by(X±S),and the t test was used to compare the samples.The metrological datas of non-normal distribution were expressed by M(P25-P75),and the difference between groups was analysed by rank-sum test.The count datas were indicated by rate(%),and tested by chi-square test.Risk factors were anslyzed by logistics regression analysis.Results:1.Comparisons of gender and age between severe or refractory group,general infection group and the control group:the gender of severe or refractory group,general infection group and control group(male%,female%)were(58.8%,41.2%),(60.4%,39.6%),(52.2%,47.8%)and there was no statistical difference in gender(p>0.05).The age in three groups were(4.92±1.64),(4.92±1.64),(4.65±2.18),and there was no statistical difference in age(p>0.05).2.Comparisons of the level of CD 19+,CD4+,CD8+and CD3+HLA-DR+in severe or refractory group,general infection group and the control group:(1)The levels of peripheral blood CD19+ in severe or refractory group,general infection group and the control group were(1 9.5 6± 2.55)%,(1 7.11±2.77)%and(16.13±1.87)%.Compared with the control group and general infection group,the level of CD19+in severe or refractory group was significantly higher,and there was statistical difference(p<0.05).The level of CD19+in general infection group was higer than that in the control group(t=1.554,p=0.124),but there was no statistical difference(p>0.05).(2)The levels of CD4+in severe or refractory group,general infection group and the control group were(36.30±4.18)%,(38.46±3.97)%and(39.35±3.86)%,respectively.Compared with the control group,the level of CD4+in severe or refractory group was lower,and there was statistical difference(p<0.05).Compared with general infection group,the level of CD4+in severe refractory group was lower than that in general infection group,but there was no statistical difference(p>0.05).There was no much difference between the level of CD4+of the cotrol group and that in general infection group,and there was no statistical difference(p>0.05).(3)The levels of CD8+in severe refractory group,general infection group and control group were(27.94±2.98)%,(28.28±2.65)%and(28.70±2.36)%,respectively.Comparing in pairs,there was no statistical difference(p>0.05).(4)The levels of CD3+HLA-DR+in severe or refractory group,general infection group and control group were 11.30(9.00,12.25)%,17.00(1 5.75,19.00)%and 19.00(18.00,20.00)%.Compared with the control group and general infection group,the level of CD3+HLA-DR+in severe or refractory group was lower,and there was statistical difference(p<0.05).Compared with the control group,the level of CD3+HLA-DR+in general infection group was lower,and there was statistical difference(p<0.05)3.Comparison of vitamin A levels among severe or refractory group,general infection group and the control group:the level of peripheral blood vitamin A in severe or refractory group,general infection group and the control group were(0.21±0.08)mg/l,(0.27±0.10)mg/l,(0.29±0.11)mg/l,respectively.Compared with the control group and general infection group,the level of Vitamin A in severe or refractory group was significantly lower,and there was statistical difference(p<0.05).Compared with the control group,the level of vitamin A in general infection group was lower,but there was no statistical difference(p>0.05).4.Analysis of risk factors of severe or refractory mycoplasma pneumoniae pneumonia:The lower levels of Vitamin A and CD3+HLA-DR+were the risk factors of severe refractory or mycoplasma pneumoniae pneumonia,and the patients with lower level of CD3+HLA-DR+were more likely to become severe or refractory cases than those with lower Vitamin A.Conclusions:1.The imbalance of lymphocyte subsets of patients who are diagnosed with severe or refractory mycoplasma pneumoniae pneumonia are more serious than that of general mycoplasma pneumoniae pneumonia.2.The deficiency of Vitamin A in patients with severe or refractory mycoplasma pneumoniae pneumonia was more serious than that of children with general mycoplasma pneumoniae pneumonia in acute stage.3.The lower levels of CD3+HLA-DR+and Vitamin A were the risk factors of severe or refractory mycoplasma pneumoniae pneumonia,and and the patients with lower level of CD3+HLA-DR+were more likely to become severe or refractory cases than those with lower Vitamin A. |
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