儿童重症肺炎支原体肺炎血清sTREM-1、MMP-9水平及临床意义

doi:10.3877/cma.j.issn.1674-6902.2021.03.007

目的

探讨儿童重症肺炎支原体肺炎血清可溶性髓系细胞触发受体-1(sTREM-1)、基质金属蛋白酶-9(MMP-9)水平及临床意义。

方法

选择2018年3月至2020年5月本院收治的76例肺炎支原体肺炎患儿，依据病情严重程度分为重症肺炎组48例、中度肺炎组28例。对比两组患儿血清sTREM-1、MMP-9水平；统计重症肺炎支原体肺炎患儿预后情况，分死亡组7例和存活组41例；分析血清sTREM-1、MMP-9水平对儿童重症肺炎支原体肺炎预后的预测价值。

结果

重症肺炎组患儿血清sTREM-1、MMP-9水平均高于中度肺炎组(P<0.05)；重症肺炎支原体肺炎患儿死亡的发生率为14.58%(48/7)。死亡组重症肺炎支原体肺炎患儿血清sTREM-1、MMP-9水平分别为(105.27±25.86)ng/L、(346.25±53.46)ng/ml均高于存活组(74.20±16.52)ng/L、(296.45±22.35)ng/ml(P<0.05)。血清sTREM-1、MMP-9预测儿童重症肺炎支原体肺炎预后的最佳截断点分别为89.65 ng/L、310.57 ng/ml。血清sTREM-1、MMP-9两者联合的特异度为97.56%，高于血清sTREM-1、MMP-9水平单独进行评估的特异度，且血清sTREM-1、MMP-9两者联合预测儿童重症肺炎支原体肺炎预后的曲线下面积为0.738，高于血清sTREM-1、MMP-9水平单独预测的AUC(P<0.05)。

结论

血清sTREM-1、MMP-9水平预测重症肺炎支原体肺炎患儿预后的评估较高，两者联合适用于对重症肺炎支原体肺炎患儿预后有意义。

关键词: 重症肺炎, 支原体肺炎, 可溶性髓系细胞触发受体-1, 基质金属蛋白酶-9

Objective

To investigate the levels of soluble myeloid cell triggering receptor-1 (sRM-1) and matrix metalloproteinase-9 (MMP-9) in serum of children with severe mycoplasma pneumoniae pneumonia and their clinical significance.

Methods

76 children with Mycoplasma pneumoniae pneumonia admitted to our hospital from March 2018 to May 2020 were selected and divided into severe pneumonia group 48 cases and moderate pneumonia group 28 cases according to the severity of their illness. Serum sTREM-1 and MMP-9 levels were compared between the two groups. The prognosis of children with severe mycoplasma pneumoniae pneumonia was analyzed and divided into death group 7 cases and survival group 41 cases. Receiver operating characteristic curve (ROC) was prepared to analyze the predictive value of serum sRM-1 and MMP-9 levels on the prognosis of children with severe Mycoplasma pneumoniae pneumonia.

Results

Serum sTREM-1 and MMP-9 levels in severe pneumonia group were higher than those in moderate pneumonia group (P<0.05). The incidence of prognostic death in children with severe mycoplasma pneumoniae pneumonia was 14.58% (7/48). Serum sRM-1 and MMP-9 levels in the death group were (105.27±25.86) ng/L and (346.25±53.46) ng/ml, respectively, higher than those in the survival group (74.20±16.52) ng/L and (296.45±22.35) ng/ml (P<0.05). ROC analysis showed that the best cutoff points of serum sRM-1 and MMP-9 for predicting the prognosis and death of children with severe Mycoplasma pneumoniae pneumonia were 89.65 ng/L and 310.57 ng/ml, respectively. The combined specificity of serum sRM-1 and MMP-9 was 97.56%, higher than that of serum sRM-1 and MMP-9 alone, and the area under the curve of the combined prediction of serum sRM-1 and MMP-9 for the prognosis of children with severe mycoplasma pneumoniae pneumonia was 0.738. Higher than the AUC predicted by serum sMOM-1 and MMP-9 levels alone (P<0.05).

Conclusion

Serum sMOM-1 and MMP-9 levels are highly effective in predicting the prognosis and death of children with severe mycoplasma pneumoniae pneumonia, and they are suitable for predicting the prognosis of children with severe mycoplasma pneumoniae pneumonia together.

Key words: Severe pneumonia, Mycoplasma pneumonia, Soluble myeloid cell trigger receptor-1, Matrix metalloproteinase-9

表1 两组患儿血清sTREM-1、MMP-9水平(±s)

组　别	例数	sTREM-1(ng/L)	MMP-9(ng/ml)
重症肺炎组	48	78.73±18.32^ab	303.71±46.42^ab
轻/中度肺炎组	28	51.32±15.47^a	128.63±25.18^a
t值		283.729	353.028
P值		<0.01	<0.01

表1 两组患儿血清sTREM-1、MMP-9水平(±s)

组　别	例数	sTREM-1(ng/L)	MMP-9(ng/ml)
重症肺炎组	48	78.73±18.32^ab	303.71±46.42^ab
轻/中度肺炎组	28	51.32±15.47^a	128.63±25.18^a
t值		283.729	353.028
P值		<0.01	<0.01

19	Hashimoto M, Kuriiwa S, Kojima A, et al. Aortic rupture involving matrix metalloproteinases 8 and 9 during Staphylococcus aureus pneumonia[J]. Thorax, 2018, 73(4): 397-398.
20	田　鑫. 重症肺炎患者血清中sTREM-1、纤维蛋白原及D-二聚体水平变化及临床意义[J]. 临床肺科杂志，2018, 23(9): 1699-1702+1719.
21	陈　静，孙　建，冯晓丽，等. 重症肺炎患者血清CD40L，VCAM-1，sTREM-1水平与病情和预后的关系[J]. 北华大学学报(自然科学版), 2020, 21(6): 81-84.
22	Zhao X, Xu L, Yang Z, et al. Significance of sTREM-1 in early prediction of ventilator-associated pneumonia in neonates: a single-center, prospective, observational study[J]. BMC Infect Dis, 2020, 20(1): 542.
23	龚英峰. 感染性肺炎新生儿血清sICAM1, sTREM-1变化及与免疫和炎症反应的相关性研究[J]. 昆明医科大学学报，2020, 41(3): 121-127.
24	陈　亮，卓　越，曾宗鼎，等. 血清和肽素MMP-9及MEWS评分预测老年重症肺炎患者预后的价值[J]. 中国急救医学，2018, 38(5): 390-394.
25	Khomiak D, Kaczmarek L. Matrix metalloproteinase 9 and epileptogenesis- the crucial role of the enzyme and strategies to prevent the disease development[J]. Postepy Biochem, 2018, 64(3): 222-230.
26	陈绵军，陈　军，谭德敏，等. 血清Copeptin、MMP-9及MEWS评分对老年重症肺炎患者的预后评估研究[J]. 中华急诊医学杂志，2018, 27(3): 271-274.
27	Matsuura R, Hamano SI, Daida A, et al. Serum matrix metallopeptidase-9 and tissue inhibitor of metalloproteinase-1 levels in autoimmune encephalitis[J]. Brain Dev, 2020, 42(3): 264-269.
28	黄莹萱，丁敏才，敖　超. 纤维支气管镜下敏感抗生素肺泡灌洗对重症肺炎患儿血清MMP-9及TIMP-1水平的影响[J]. 广西医科大学学报，2020, 37(4): 194-198.
29	胡　晶，朱　敏，苏华平，等. 肺炎患儿血清G-CSF、sTREM-1、sICAM-1水平的变化及意义[J]. 检验医学与临床，2018, 15(6): 817-820.
30	Ueland T, Holter JC, Holten AR, et al. Distinct and early increase in circulating MMP-9 in COVID-19 patients with respiratory failure[J]. J Infect, 2020, 81(3): e41-e43.
1	Lee H, Yun KW, Lee HJ, et al. Antimicrobial therapy of macrolide-resistant Mycoplasma pneumoniae pneumonia in children[J]. Expert Rev Anti Infect Ther, 2018, 16(1): 23-34.
2	Akkus A, Torun EG, Yazici MU, et al. Severe mycoplasma encephalitis in a child: the corticosteroid treatment [J]. Klin Padiatr, 2020, 232(4): 219-221.
3	Krafft C, Christy C. Mycoplasma pneumonia in children and adolescents [J]. Pediatr Rev, 2020, 41(1): 12-19.
4	关　敏，白雪梅. 几种常见炎症因子在小儿重症肺炎支原体肺炎中的临床意义[J]. 中国小儿急救医学，2020, 27(5): 371-374.
5	邓云森，李盛强，林丽妮，等. 血清25-(OH)D, hs-CRP, PCT与新生儿重症肺炎的关系研究[J]. 中国急救复苏与灾害医学杂志，2020，15(1): 75-77.
6	Wang X, Zhong LJ, Chen ZM, et al. Necrotizing pneumonia caused by refractory Mycoplasma pneumonia pneumonia in children [J]. World J Pediatr, 2018, 14(4): 344-349.
7	左　玉，王震文，王　栋，等. 血清MCP-1, sTREM-1, sICAM-1在肺炎患儿表达水平及其与病情严重程度的相关性分析[J]. 标记免疫分析与临床，2019, 153(7): 111-114+120.
8	Yamauchi M, Kinjo T, Parrott G, et al. Diagnostic performance of serum interferon gamma, matrix metalloproteinases, and periostin measurements for pulmonary tuberculosis in Japanese patients with pneumonia[J]. PLoS One, 2020, 15(1): 227-231.
9	胡亚美，江载芳. 诸福棠实用儿科学(第7版)(上下)(精)[M]. 北京：人民卫生出版社，2012: 56-60.
10	陈志敏，尚云晓，赵顺英，等. 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J]. 中华实用儿科临床杂志，2015, 17(3): 1304-1308.
11	李昌崇，尚云晓，沈叙庄，等. 儿童社区获得性肺炎管理指南(2013修订)(下)[J]. 中华儿科杂志，2013, 11(8): 856-862.
12	Liu J, He R, Wu R, et al. Mycoplasma pneumoniae pneumonia associated thrombosis at Beijing Children′s hospital[J]. BMC Infect Dis, 2020, 20(1): 51.
13	Rodman Berlot J, Krivec U, Praprotnik M, et al. Clinical characteristics of infections caused by Mycoplasma pneumoniae P1 genotypes in children[J]. Eur J Clin Microbiol Infect Dis, 2018, 37(7): 1265-1272.
14	张　利，李劲松，段宝珍. 临床征象对儿童社区获得性肺炎支原体肺炎的鉴别价值[J/CD]. 中华肺部疾病杂志(电子版), 2017, 10(6): 725-727.
15	Yan C, Xue G, Zhao H, et al. Molecular and clinical characteristics of severe Mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2019, 54(7): 1012-1021.
16	何国兵，陆建华. 甲泼尼龙、阿奇霉素序贯治疗儿童支原体肺炎的CRP、sTREM-1水平的影响及预后分析[J]. 中国妇幼保健，2019, 34(5): 1080-1082.
17	Puljiz I, Markotic A, Cvetko Krajinovic L, et al. Mycoplasma pneumoniae in adult community-acquired pneumonia increases matrix metalloproteinase-9 serum level and induces its gene expression in peripheral blood mononuclear cells[J]. Med Sci Monit, 2012, 18(8): 500-505.
18	谭家余，黄　湘，邬敏志，等. 肺泡液可溶性髓系细胞触发受体-1水平对呼吸机相关性肺炎早期诊断价值的Meta分析[J]. 中华危重病急救医学，2020, 32(9): 1067-1073.

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Serum sTREM-1 and MMP-9 levels in children with severe mycoplasma pneumoniae pneumonia and the clinical significance

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Serum sTREM-1 and MMP-9 levels in children with severe mycoplasma pneumoniae pneumonia and the clinical significance