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重症腺病毒肺炎患儿凝血功能和免疫功能特征及其临床意义

Characteristics of coagulation function and immune function in children with severe adenovirus pneumonia and their clinical significance

    摘要
  • 摘要:
    目的 探讨重症腺病毒肺炎患儿凝血功能和免疫功能特征及其临床意义。
    方法 选取122例重症腺病毒肺炎患儿和120例非重症腺病毒肺炎患儿为研究对象, 分别设为重症组和非重症组; 根据预后将重症组患儿分为预后良好组(n=105)和预后不良组(n=17)。另选取同期120例体检健康儿童为对照组。检测凝血功能指标，包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT); 采用散射免疫比浊法检测免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平; 采用多因素Cox回归分析探讨预后不良的影响因素。
    结果 与对照组比较，非重症组和重症组患儿白细胞(WBC)、中性粒细胞(N)、C反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞介素-6(IL-6)、降钙素原(PCT)、FIB、IgG水平升高, B淋巴细胞、自然杀伤(NK) 细胞、PT、APTT、IgA、IgM水平降低，差异有统计学意义(P < 0.05); 与非重症组比较，重症组患儿WBC、N、CRP、ESR、IL-6、PCT、FIB、IgG水平升高，B淋巴细胞、NK细胞、PT、APTT、IgA、IgM水平降低，差异有统计学意义(P < 0.05)。与预后良好组相比，预后不良组CRP、IL-6、PCT、IgG水平升高, APTT、IgM、IgA水平降低，差异有统计学意义(P < 0.05)。多因素Cox回归分析结果显示, PCT、APTT、IgM为重症患儿预后不良的影响因素(P < 0.05)。
    结论 重症腺病毒肺炎患儿PT、APTT、IgA、IgM水平降低, FIB、IgG水平升高，凝血和免疫功能指标与重症腺病毒肺炎预后状况相关。

     

    Abstract:
    Objective To explore the characteristics of coagulation and immune function and their clinical significance in children with severe adenovirus pneumonia (SAP).
    Methods A total of 122 children with SAP and 120 children with non-severe adenovirus pneumonia (NSAP) were enrolled and assigned to severe group and non-severe group. The severe group was further subdivided into good prognosis subgroup (n=105) and poor prognosis subgroup (n=17) according to prognosis. Additionally, 120 healthy children undergoing physical examination during the same period were included as control group. Coagulation function indicators, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and thrombin time (TT) were measured. Levels of immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) were determined using the nephelometric immunoassay. Multivariate Cox regression analysis was conducted to explore the influencing factors of poor prognosis.
    Results Compared with the control group, children in both the non-severe and severe groups exhibited increased levels of white blood cells (WBC), neutrophils (N), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), procalcitonin (PCT), FIB, and IgG, as well as decreased levels of B lymphocytes, natural killer (NK) cells, PT, APTT, IgA, and IgM (P < 0.05). Compared with the non-severe group, children in the severe group showed increased levels of WBC, N, CRP, ESR, IL-6, PCT, FIB, and IgG, as well as decreased levels of B lymphocytes, NK cells, PT, APTT, IgA, and IgM (P < 0.05). Compared with the good prognosis subgroup, the poor prognosis subgroup exhibited increased levels of CRP, IL-6, PCT, and IgG, as well as decreased levels of APTT, IgM, and IgA (P < 0.05). The results of multivariate Cox regression analysis showed that PCT, APTT, and IgM were influencing factors of poor prognosis in children with SAP (P < 0.05).
    Conclusion Children with SAP have decreased levels of PT, APTT, IgA, and IgM, as well as increased levels of FIB and IgG. Coagulation and immune function indicators are correlated with the prognosis of SAP.

     

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