中性粒细胞胞外诱捕网标记物游离DNA与儿童肺炎支原体肺炎的关系

doi:10.3969/j.issn.1006-5725.2025.23.012

摘要/Abstract

摘要：

目的分析中性粒细胞胞外诱捕网（NETs）标记物游离DNA（cf-DNA）在肺炎支原体肺炎（MPP）患儿体内的表达水平，探讨cf-DNA/NETs对MPP患儿病情严重程度的预测效能。方法前瞻性选取115例MPP患儿作为MPP组，根据病情严重程度，将MPP组分为轻症组（n = 75）和重症组（n = 40）。同期随机选取50例健康体检儿童作为对照组。检测MPP组及对照组血清cf-DNA水平及MPP组C反应蛋白（CRP）、D-二聚体、乳酸脱氢酶（LDH）、白介素-6（IL-6）、γ干扰素（IFN-γ）及肿瘤坏死因子-α（TNF-α）水平，比较各组血清cf-DNA及相关炎症因子的水平差异，并分析血清cf-DNA在评估MPP病情严重程度中的作用。结果 MPP组患儿血清cf-DNA水平较对照组明显升高，且在重症组升高更显著（P < 0.05）。重症组CRP、D-二聚体、LDH、IL-6、IFN-γ及TNF-α水平均高于轻症组（P < 0.05）。多因素logistic回归分析发现血清cf-DNA、CRP及IL-6水平升高与MPP病情严重程度密切相关（P < 0.05）。受试者操作特征曲线分析结果显示血清cf-DNA、CRP及IL-6三者联合预测重症MPP的曲线下面积为0.981，高于各指标单独预测（P < 0.05）。结论血清cf-DNA/NETs与MPP患儿病情严重程度密切相关，cf-DNA、CRP及IL-6三者联合检测更有利于判断MPP患儿的病情严重程度。

关键词: 肺炎支原体肺炎, 中性粒细胞胞外诱捕网, C反应蛋白, 白细胞介素-6

Abstract:

Objective The aim of this study is to analyze the expression level of cell-free DNA （cf-DNA）， a biomarker of neutrophil extracellular traps （NETs）， in children with Mycoplasma pneumoniae pneumonia （MPP）， and to explore the predictive efficacy of cf-DNA （as a marker of NETs） for the severity of MPP in these children. Methods A total of 115 children with MPP were prospectively selected as the MPP group. Based on the disease severity， the MPP group was categorized into the mild group （n = 75） and the severe group （n = 40）. During the same period， 50 healthy children undergoing physical examinations were selected as the control group. The levels of serum cf-DNA in the MPP group and the control group， as well as the levels of C-reactive protein （CRP）， D-dimer， lactate dehydrogenase （LDH）， interleukin-6 （IL-6）， interferon-γ （IFN-γ）， and tumor necrosis factor-α （TNF-α） in the MPP group were detected. The differences in the levels of serum cf-DNA and related inflammatory factors among the groups were compared， and the role of serum cf-DNA in evaluating the severity of MPP was analyzed. Results The level of serum cf-DNA in children of the MPP group was notably higher than that in the control group， with a more significant elevation observed in the severe group （P < 0.05）. The levels of CRP， D-dimer， LDH， IL-6， IFN-γ， and TNF-α were all higher in the severe group than in the mild group （P < 0.05）. Multivariate logistic regression analysis showed that the increased levels of serum cf-DNA， CRP， and IL-6 were closely related to the severity of MPP （P < 0.05）. The results of receiver operating characteristic （ROC） curve analysis showed that the area under the curve （AUC） of the combination of serum cf-DNA， CRP， and IL-6 for predicting severe MPP was 0.981， which was higher than that of each index alone （P < 0.05）. Conclusions Serum cf-DNA （as a marker of NETs） is closely related to the severity of MPP in children. The combined detection of cf-DNA， CRP， and IL-6 is more beneficial for assessing the severity of MPP in children.

Key words: mycoplasma pneumoniae pneumonia, neutrophil extracellular traps, C reactive protein, interleukin-6

中图分类号:

R725.6

杨雪妮,胡宜航,纪敏,李玉勤,卢红艳,常明. 中性粒细胞胞外诱捕网标记物游离DNA与儿童肺炎支原体肺炎的关系[J]. 实用医学杂志, 2025, 41(23): 3711-3716.

Xueni YANG,Yihang HU,Min JI,Yuqin LI,Hongyan LU,Ming. CHANG. Association between neutrophic extracellular trap marker （cell⁃free DNA） and mycoplasma pneumoniae pneumonia in children[J]. The Journal of Practical Medicine, 2025, 41(23): 3711-3716.

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项目	对照组（n = 50）	MPP组（n = 115）	χ²/t值	P值
性别/例			2.511	0.113
男	28	49
女	22	66
年龄/岁	6.06 ± 1.42	5.20 ± 2.25	1.347	0.181
WBC/（× 10⁹/L）	5.98 ± 1.30	9.01 ± 2.47	5.817	< 0.001
cf-DNA/（ng/mL）	103.60 ± 32.05	233.60 ± 50.75	16.700	< 0.001

项目	轻症组（n = 75）	重症组（n = 40）	χ²/t值	P值
性别（男/女）/例	35/40	14/26	1.452	0.228
年龄/岁	4.95 ± 2.23	5.67 ± 2.23	1.660	0.100
WBC/（× 10⁹/L）	8.46 ± 2.10	10.03 ± 2.80	3.383	0.001
cf-DNA/（ng/mL）	206.70 ± 36.59	283.90 ± 31.60	11.290	< 0.001
CRP/（mg/L）	15.74 ± 4.19	28.20 ± 8.20	10.780	< 0.001
D-二聚体/（mg/L）	0.65 ± 0.26	1.70 ± 0.73	10.140	< 0.001
LDH/（U/L）	335.10 ± 55.89	382.50 ± 95.63	3.357	0.001
IL-6/（pg/mL）	19.40 ± 5.09	30.35 ± 7.33	9.380	< 0.001
TNF-α/（pg/mL）	6.48 ± 3.86	8.87 ± 3.73	3.183	0.002
IFN-γ/（pg/mL）	15.89 ± 4.37	24.16 ± 7.35	7.562	< 0.001

指标	cf-DNA
指标	r值	P值
CRP	0.629	< 0.001
D-二聚体	0.671	< 0.001
LDH	0.318	< 0.001
IL-6	0.522	< 0.001
TNF-α	0.403	< 0.001
IFN-γ	0.503	< 0.001

指标	β	SE	Waldχ²	P值	OR	95%CI
cf-DNA	0.044	0.019	5.479	0.019	1.045	1.007 ~ 1.084
CRP	0.228	0.112	4.164	0.041	1.256	1.009 ~ 1.564
D-二聚体	0.519	1.022	0.258	0.612	1.680	0.227 ~ 12.452
LDH	0.007	0.008	0.793	0.373	1.007	0.992 ~ 1.022
IL-6	0.178	0.081	4.812	0.028	1.195	1.019 ~ 1.401
TNF-α	0.179	0.138	1.678	0.195	1.196	0.912 ~ 1.568
IFN-γ	0.015	0.107	0.020	0.887	1.015	0.824 ~ 1.251

指标	AUC	95%CI	约登指数	截断值	灵敏度	特异度	P值
cf-DNA	0.945	0.907 ~ 0.983	0.755	252.50 ng/mL	0.875	0.880	< 0.001
CRP	0.927	0.878 ~ 0.975	0.722	22.50 mg/L	0.775	0.947	< 0.001
IL-6	0.856	0.768 ~ 0.945	0.710	27.36 pg/mL	0.750	0.960	< 0.001
三者联合	0.981	0.960 ~ 1.000	0.898	-	0.925	0.973	< 0.001