摘要目的 探讨难治性肺炎支原体肺炎(refractory Mycoplasma pneumoniae pneumonia,RMPP)的支气管镜下表现的特点及支气管肺泡灌洗液(bronchoalveolar lavage fluid,BALF)中IL-17、IL-18、PTX3的临床意义.方法 选取在急性期行纤维支气管镜检查并且诊断RMPP的患儿60例以及诊断普通肺炎支原体肺炎(MPP)患儿35例作为试验组,同期行支气管异物取出术的患儿35例作为对照组.回顾性分析RMPP以及普通MPP患儿的支气管镜下表现.选取留取BALF的病例,采用ELISA方法检测BALF中IL-17、IL-18及PTX3水平.结果 (1)RMPP组支气管镜下发现黏膜糜烂、坏死黏膜脱落、痰栓形成、塑形性支气管炎的比例较普通MPP组明显增高.(2)所有MPP患儿的BALF中三种炎症因子水平较支气管异物对照组均明显升高(P＜0.05),但仅有IL-18在RMPP组与普通MPP组间差异有统计学意义(P＜0.05).使用糖皮质激素治疗的RMPP患儿BALF的三种炎症因子较未使用糖皮质激素的RMPP组明显下降(P＜0.05).结论 支气管镜下的黏膜糜烂、坏死黏膜脱落、痰栓及塑形性支气管炎对RMPP具有提示作用,IL-17、IL-18及PTX3参与了MPP的发病过程,IL-18可作为预测RMPP的相关生物学指标.此外静脉用糖皮质激素可抑制炎症因子的释放.

abstractsObjective To investigate the specpfic electric fiberobronchoscopic manifestations of refractory Mycoplasma pneumoniae pneumonia(RMPP) and explore the level of IL-17,IL-18,PTX3 in bronchoalveolar lavage fluid(BALF) and their clinical sigfinance.Methods To select patients who were diagnosed as MPP and examined by fiberobronchoscopy in acute stage.Dividing them into groups:(1) RMPP group (60cases):dividing RMPP patients into three groups according to if they were treated by systemic corticosteroids or immunoglobulin before the examination of fiberbronchoscope,① RMPP-A group:both are not used.②RMPP-B group:use systemic corticosteroids.③ RMPP-C:both are used.(2)general MPP group(35 cases).15 children with foreign body in bronchus were enrolled as control group.Firstly,to analysis the electric fiberobronchoscopic manifestations of all the cases.Secondly,the cases who had BALF samples in all group were selected,the levels of IL-17,IL-18 and PTX3 are detected by ELISA.Results Under electric fiberobronchoscopy,that the proportions of RMPP group with mucosal erosion,necrotic mucous membrane peeling,sputum bolt blockage in bronchial lumen or moulding are higher than general MPP group.The levels of IL-17,IL-18 and PTX3 in BALF of all MPP cases are higher than control group (P ＜ 0.05),but only the difference of IL-18 between RMPP group and general MPP group has statistical significance (P ＜ 0.05).The levels of IL-17,IL-18 and PTX3 in BALF of RMPP-B group are all higher than RMPP-A group (P ＜ 0.05).Conclusion Mucosal erosion,necrotic mucosa peeling and sputum bolt,moulding are the characteristic manifestations of RMPP,and can help identify RMPP.IL-17,IL-l8 and PTX3 all participated in the pathogenesis of RMPP.Only the level of IL-18 in BALF can be the predictive marker of RMPP.Systemic corticosteroids may inhibit the levels of IL-17,IL-18 and PTX3 of RMPP patients.