标题：重症肺炎支原体肺炎患儿血清 sCD163、NLRP3、IL-37的检测及其临床意义

      作者：张大新 1，吴凯利 1，付晨 1，张玉文 2    商丘市第四人民医院儿科 1、医务科 2，河南 商丘 476000

      卷次： 2024年35卷9期

      【摘要】 目的 检测重症肺炎支原体肺炎(MPP)患儿血清可溶性血红蛋白清道夫受体 s (sCD163)、NOD样受体蛋白3 (NLRP3)、白细胞介素(IL)-37水平并探讨其临床意义。方法 选取2021年1月至2023年6月商丘市第四人民医院收治的 112例重症MPP患儿作为重症MPP组，另选取同期收治的 112例轻症MPP患儿作为轻症MPP组。比较两组患儿的血清 sCD163、NLRP3、IL-37水平，以及不同临床表现重症MPP患儿和不同预后患儿的血清 sCD163、NLRP3、IL-37水平。采用Spearman相关性分析血清 sCD163、NLRP3、IL-37水平与重症MPP患儿预后的关系，绘制受试者工作特征曲线(ROC)评价血清 sCD163、NLRP3、IL-37水平对重症MPP患儿预后的预测价值。结果 重症MPP组患儿的血清 sCD163、NLRP3、IL-37分别为(157.16±45.19) pg/mL、(12.96±3.41) μg/mL、(102.49±30.25) pg/mL，明显高于轻症MPP组的(114.83±37.39) pg/mL、(7.45±2.17) μg/mL、(67.42±24.83) pg/mL，差异均有统计学意义(P<0.05)；有肺实变、肺不张、胸腔积液及肺外并发症患儿的血清 sCD163、NLRP3、IL-37水平均分别高于无肺实变、肺不张、胸腔积液及肺外并发症患儿，差异均有统计学意义(P<0.05)；治疗1个月后，重症MPP患儿中 35例预后不良，77例预后良好，预后不良患儿的血清 sCD163、NLRP3、IL-37分别为(194.33±58.63) pg/mL、(18.47±6.11) μg/mL、(124.83±30.45) pg/mL，明显高于预后良好患儿的(140.26±40.25) pg/mL、(10.46±3.27) μg/mL、(92.34±25.34) pg/mL，差异均有统计学意义(P<0.05)；经 Spearman相关性分析结果显示，血清 sCD163、NLRP3、IL-37水平与重症MPP患儿预后呈正相关(P<0.05)；经ROC分析结果显示，血清 sCD163、NLRP3、IL-37水平预测重症MPP患儿预后不良的曲线下面积(AUC)值分别为0.796、0.765、0.737，三者联合预测预后不良的AUC值为0.923，明显高于各指标单独预测，敏感度、特异度分别为 88.57%、83.12%。结论 重症MPP患儿血清 sCD163、NLRP3、IL-37水平升高与预后不良密切相关，三者联合有望成为预测重症MPP患儿预后的重要指标。
      【关键词】 肺炎支原体肺炎；可溶性血红蛋白清道夫受体s；NOD样受体蛋白3；白细胞介素-37；病情程度；预后
      【中图分类号】 R725.5 【文献标识码】 A 【文章编号】 1003—6350（2024）09—1307—05

Detection and clinical significance of serum sCD163, NLRP3, and IL-37 in children with severe pneumoniacaused by Mycoplasma pneumoniae pneumonia.
ZHANG Da-xin 1, WU Kai-li 1, FU Chen 1, ZHANG Yu-wen 2.Department of Pediatrics 1, Department of Medical Affairs 2, the Fourth People's Hospital of Shangqiu, Shangqiu 476000,Henan, CHINA
【Abstract】 Objective To detect the levels of soluble hemoglobin scavenger receptor CD163 (sCD163), NODlike receptor protein 3 (NLRP3), interleukin-37 (IL-37) in the serum of children with severe Mycoplasma pneumoniaepneumonia (MPP) and explore their clinical significance. Methods A total of 112 children with severe MPP admittedto the Fourth People's Hospital of Shangqiu from January 2021 to June 2023 were selected as the severe MPP group, andanother 112 children with mild MPP admitted to the hospital during the same period were selected as the mild MPPgroup. The levels of serum sCD163, NLRP3, and IL-37 in the two groups of children were compared, as well as the lev-els of serum sCD163, NLRP3, and IL-37 in children with severe MPP with different clinical manifestations and childrenwith different prognoses. Spearman correlation analysis was used to evaluate the relationship between the levels of se-rum sCD163, NLRP3, and IL-37 and the prognosis of children with severe MPP. Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of serum sCD163, NLRP3, and IL-37 levels for the prognosis ofchildren with severe MPP. Results The serum levels of sCD163, NLRP3, and IL-37 in children with severe MPP were(157.16±45.19) pg/mL, (12.96±3.41) μg/mL, and (102.49±30.25) pg/mL, respectively, which were significantly higherthan (114.83±37.39) pg/mL, (7.45±2.17) μg/mL, and (67.42±24.83) pg/mL in children with mild MPP (P<0.05). The se-rum levels of sCD163, NLRP3, and IL-37 in children with pulmonary consolidation, atelectasis, pleural effusion, and ex-trapulmonary complications were significantly higher than those in children without pulmonary consolidation, atelecta-sis, pleural effusion, and extrapulmonary complications (P<0.05). At one month after treatment, 35 children with severeMPP had a poor prognosis and 77 had a good prognosis; the serum levels of sCD163, NLRP3, and IL-37 in childrenwith poor prognosis were (194.33±58.63) pg/mL, (18.47±6.11) μg/mL, and (124.83±30.45) pg/mL, respectively, whichwere significantly higher than (140.26 ±40.25) pg/mL, (10.46±3.27) μg/mL, and (92.34±25.34) pg/mL in children withgood prognosis (P<0.05). Spearman correlation analysis showed that the serum levels of sCD163, NLRP3, and IL-37were positively correlated with the prognosis of severe MPP children (P<0.05). ROC analysis showed that the areas un-der the curve (AUC) values of serum sCD163, NLRP3, and IL-37 for predicting poor prognosis in children with se-vere MPP were 0.796, 0.765, and 0.737, respectively. The combined AUC value of the three was 0.923, which wassignificantly higher than that of each individual indicator, with a sensitivity and specificity of 88.57% and 83.12%,respectively. Conclusion The elevated levels of serum sCD163, NLRP3 and IL-37 in children with severe MPP areclosely related to poor prognosis. The combination of SCD163, NLRP3 and IL-37 may be an important predictor ofprognosis in children with severe MPP.
      【Key words】 Mycoplasma pneumoniae pneumonia; Soluble hemoglobin scavenger receptor CD163 (sCD163);NOD like receptor protein 3 (NLRP3); Interleukin-37 (IL-37); Degree of illness; Prognosis