摘要目的:分析难治性肺炎支原体肺炎患儿T细胞亚群、白细胞介素（IL）-8、IL-10、调节激活正常T细胞表达和分泌因子（RANTES）的检测水平及其意义。方法:选取郑州大学附属儿童医院2018年7月至2021年1月收治的支气管狭窄患儿进行前瞻性研究，根据不同感染类型分组，难治性肺炎支原体肺炎患儿34例为观察组，普通支气管肺炎患儿32例为肺炎组，支气管狭窄、需做纤维支气管镜、无感染病灶的儿童31例为对照组。观察组男21例，女13例，年龄（7.43±1.09）岁。肺炎组男20例，女12例，年龄（7.24±1.15）岁。对照组男20例，女11例，年龄（7.06±1.20）岁。均行T细胞亚群、IL-8、IL-10、RANTES检测，比较3组CD4 +、CD8 +、IL-8、IL-10、RANTES水平，分析观察组不同因子水平与病情程度的相关性，并进行多因素分析。 结果:观察组CD4 +、CD8 +、IL-8、IL-10、RANTES水平分别为（22.53±4.19）%、（22.11±2.03）%、（26.38±4.25）pg/ml、（15.73±2.11）pg/ml、（33.51±3.17）μg/L，肺炎组分别为（34.36±4.93）%、（26.62±2.35）%、（14.16±2.91）pg/ml、（11.06±1.85）pg/ml、（30.06±3.26）μg/L，对照组分别为（35.12±6.75）%、（27.06±3.15）%、（7.52±1.69）pg/ml、（7.90±1.66）pg/ml、（26.84±3.12）μg/L，3组CD4 +、CD8 +、IL-8、IL-10、RANTES水平比较差异均有统计学意义（均 P＜0.05），且观察组CD4 +、CD8 +水平均低于肺炎组、对照组，IL-8、IL-10、RANTES水平均高于肺炎组、对照组（均 P＜0.05）；不同严重程度难治性支原体肺炎患儿CD4 +、CD8 +、IL-8、IL-10、RANTES水平比较差异均有统计学意义（均 P＜0.05），随病情程度加重CD4 +、CD8 +水平呈下降趋势，IL-8、IL-10、RANTES水平呈上升趋势（均 P＜0.05）；CD4 +、CD8 +水平与难治性肺炎支原体肺炎患儿病情严重程度呈负相关（ r1=-0.516， P1＜0.001； r2=-0.489， P2＜0.001），IL-8、IL-10、RANTES水平与病情严重程度呈正相关（ r1=0.564， P1＜0.001； r2=0.612， P2＜0.001； r3=0.441， P3＜0.001）；CD4 +（ OR=0.336， P＜0.001，95% CI为0.148～0.762）、CD8 +（ OR=0.355， P＜0.001，95% CI为0.194～0.651）、IL-8（ OR=4.028， P＜0.001，95% CI为2.338～6.941）、IL-10（ OR=3.209， P＜0.001，95% CI为1.945～5.296）、RANTES（ OR=5.588， P＜0.001，95% CI为3.849～8.114）水平均为难治性肺炎支原体肺炎患儿病情严重程度的影响因素。 结论:难治性肺炎支原体肺炎患儿CD4 +、CD8 +水平呈低表达，IL-8、IL-10、RANTES水平呈高表达，且CD4 +、CD8 +、IL-8、IL-10、RANTES水平可用于分析难治性肺炎支原体患儿病情程度，有助于为临床制定干预措施提供客观依据，具有重要临床价值。

abstractsObjective:To analyze the levels and significance of T cell subsets, interleukin-8 (IL-8), IL-10, and regulatory activated normal T cell expression and secretion factor (RANTES) in children with refractory mycoplasma pneumoniae pneumonia.Methods:From July 2018 to January 2021, the children with bronchial stenosis treated in Zhengzhou Children's Hospital were selected for the prospective study. According to different types of infection, 34 children with refractory mycoplasma pneumoniae pneumonia were set as an observation group, 32 children with common bronchial pneumonia as a pneumonia group, and 31 children with bronchial stenosis who needed fiberoptic bronchoscopy and had no infection focus as a control group. In the observation group, there were 21 males and 13 females, and they were (7.43±1.09) years old. In the pneumonia group, there were 20 males and 12 females, and they were (7.24±1.15) years old. In the control group, there were 20 males and 11 females, and they were (7.06±1.20) years old. The T-cell subsets, IL-8, IL-10, and RANTES were detected in all the groups. The levels of CD4 +, CD8 +, IL-8, IL-10, and RANTES in the three groups were compared, and the correlation between different factor levels and the disease severity in the observation group was analyzed, and multivariate analysis was performed. Results:The levels of CD4 +, CD8 +, IL-8, IL-10, and RANTES were (22.53±4.19)%, (22.11±2.03)%, (26.38±4.25) pg/ml, (15.73±2.11) pg/ml, and (33.51±3.17) μg/L in the observation group, were (34.36±4.93)%, (26.62±2.35)%, (14.16±2.91) pg/ml, (11.06±1.85) pg/ml, and (30.06±3.26) μg/L in the pneumonia group, and were (35.12±6.75)%, (27.06±3.15)%, (7.52±1.69) pg/ml, (7.90±1.66) pg/ml, and (26.84±3.12) μg/L in the control group, with statistical differences (all P＜0.05). The levels of CD4 + and CD8 + in the observation group were lower than those in the pneumonia group and the control group, while the levels of IL-8, IL-10, and RANTES were higher than those in the pneumonia group and the control group (all P＜0.05). There were statistical differences in the levels of CD4 +, CD8 +, IL-8, IL-10 and RANTES between the patients with refractory mycoplasma pneumoniae pneumonia of different degrees (all P＜0.0); with the aggravation of the disease, the levels of CD4 + and CD8 + showed a downward trend, while the levels of IL-8, IL-10 and RANTES showed an upward trend (all P＜0.05). The levels of CD4 + and CD8 + were negatively correlated with the disease severity of the children with refractory mycoplasma pneumoniae pneumonia ( r1=-0.516, P1＜0.001; r2=-0.489, P2＜0.001). The levels of IL-8, IL-10, and RANTES were positively correlated with the disease ( r1=0.564, P1＜0.001; r2=0.612, P2＜0.001; and r3=0.441, P3＜0.001). The levels of CD4 + ( OR=0.336, P＜0.001, 95%CI 0.148-0.762), CD8 + ( OR=0.355, P＜0.001, 95%CI 0.194-0.651), IL-8 ( OR=4.028, P＜0.001, 95%CI 2.338-6.941), IL-10 ( OR=3.209, P＜0.001, 95%CI 1.945-5.296), and RANTES ( OR=5.588, P＜0.001, 95%CI 3.849-8.114) were all the influencing factors of the disease severity of the children with refractory mycoplasma pneumoniae pneumonia. Conclusions:The levels of CD4 + and CD8 + in children with refractory mycoplasma pneumoniae pneumonia are low expressed, while the levels of IL-8, IL-10, and RANTES high expressed. The levels of CD4 +, CD8 +, IL-8, IL-10, and RANTES can be used to analyze the disease severity of children with refractory mycoplasma pneumoniae pneumonia, which is helpful to provide objective basis for clinical intervention and has important clinical value.