重症肺炎支原体肺炎患儿早期淋巴细胞亚群表型特征及支气管镜检查表现

doi:10.3969/j.issn.1006-5725.2025.07.020

Abstract

Abstract:

Objective To investigate the value of the absolute number of lymphocyte subpopulations as an early warning indicator for children with SMPP（severe mycoplasma pneumonia， SMPP） and to analyze the characteristics observed via bronchoscopy， thereby providing a valuable reference for the early diagnosis of SMPP. Methods This study included 102 children with Mycoplasma pneumoniae pneumonia （MPP）， comprising 54 cases of common MPP and 48 cases of SMPP. The lymphocyte subpopulations， clinical characteristics， and laboratory indicators were analyzed. Results There were statistically significant differences between the two groups in the absolute number levels of lymphocyte subpopulations CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， CD3^-/CD16⁺CD56⁺NK cells （P < 0.05）. The absolute numbers of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells showed negative correlations with serum ferritin， LDH， CRP， and D?D， respectively （P < 0.05）. Multifactorial logistic regression analysis identified the absolute numbers of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells as independent risk factors for severe Mycoplasma pneumoniae pneumonia （SMPP）. ROC analysis demonstrated that the areas under the curve for diagnosing SMPP based on the absolute numbers of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells were 0.711， 0.887， 0.856， and 0.860， respectively， with sensitivities of 47.4%， 80.8%， 82.1%， and 92.3%， and specificities of 89.7%， 87.2%， 75%， and 70.5%， respectively. The combined ROC curve of the four lymphocyte subsets had an area of 0.983， with a sensitivity of 97.4% and specificity of 92.3%. The proportions of bronchoscopy findings and microscopic examination of mucus plugs in the SMPP group were significantly higher than those in the ordinary MPP group （P < 0.05）. In the mucoid plug subgroup， the absolute numbers of CD3?CD19?T cells and CD4?T cells were significantly lower compared to the non?mucoid plug subgroup， while the percentage of CD8?T cells increased and the CD4?/CD8? ratio decreased （all P < 0.05）. Conclusions The absolute number of CD3⁺CD19^-T， CD4⁺T， CD3^-CD19⁺B， and CD3^-/CD16⁺CD56⁺NK cells in peripheral blood serves as a highly sensitive and specific predictor of small airway mucus plugging phenomenon （SMPP） and can thus be utilized as a potential biomarker for SMPP. Microscopic analysis under SMPP conditions reveals a high prevalence of mucus plugs， necessitating proactive bronchoscopic intervention. Furthermore， the significant imbalance in T cell subpopulations is strongly correlated with the formation of mucus plugs observed during bronchoscopy.

Key words: children, severe mycoplasma pneumonia, lymphocyte subset phenotypes, bronchoscopy

CLC Number:

R515.2

Pao YU,Feng ZHU,Zheng GE,Bi ZHOU,Lixia ZHANG. Phenotypic characteristics of early lymphocyte subsets and bronchoscopy findings in children with severe Mycoplasma pneumoniae pneumonia[J]. The Journal of Practical Medicine, 2025, 41(7): 1062-1069.

Figures/Tables 6

Tab.1

Comparison of demographic characteristics， clinical characteristics， and laboratory test results of children in the SMPP group and the ordinary MPP group"

项目	总体（n = 102）	普通MPP（n = 54）	SMPP（n = 48）	t/χ ² 值	P值
年龄（x ± s）/岁	4.98 ± 1.48	4.86 ± 1.45	5.21 ± 1.52	-1.709	0.09
性别/［例（%）］				0.054	0.82
男	54（52）	28（51）	26（54）
女	48（48）	26（49）	22（46）
入院前发热时间/d	4.4（2.9， 6.7）	4.4（2.9， 6.7）	4.5（3.0， 6.6）	6 114.5	0.95
入院前应用大环内酯类药物/［例（%）］	61（59）	31（58）	30（62）	0.179	0.67
住院时间/d	7.8（5.2， 11.0）	6.4（4.3， 8.2）	12.2（9.4， 15.6）	1512	< 0.01
胸腔积液/［例（%）］	41（40）	1（2）	40（83）	163.251	< 0.01
肺实变/［例（%）］	44（43）	2（3）	42（88）	174.771	< 0.01
二个以上系统受累/［例（%）］	33（32）	11（21）	22（45）	13.931	< 0.01
铁蛋白（x ± s）/（ng/mL）	166.13 ± 66.76	143.81 ± 58.21	210.77 ± 60.33	-8.097	< 0.01
ESR/（mm/h）	35（28， 43）	35（25， 43）	37（32， 42）	5449	0.19
PCT（x ± s）/（pg/L）	0.29 ± 0.12	0.28 ± 0.13	0.3 ± 0.12	-0.8	0.42
CRP（x ± s）/（mg/L）	19.7 ± 5.98	17.6 ± 4.89	23.9 ± 5.78	-8.267	< 0.01
LDH（x ± s）/（U/L）	266.88 ± 69.86	243.01 ± 57.81	314.63 ± 67.64	-8.003	< 0.01
ALT（x ± s）/（U/L）	59.23 ± 9.88	59.55 ± 8.91	58.58 ± 11.6	0.645	0.52
白细胞计数（x ± s）/（× 10⁹/L）	8.65 ± 3.33	8.92 ± 3.61	8.13 ± 2.63	1.894	0.06
淋巴细胞计数/（个/μL）	2 130（1 676.75， 2 585.25）	2 191（1 690， 2 687）	2 047.5（1 634， 2 342.5）	7 440.5	< 0.01
D-D/（μg/mL）	0.54（0.43， 0.68）	0.49（0.40， 0.56）	0.74（0.62， 0.94）	1 472.5	< 0.01
CD3⁺CD19 ^- T细胞计数/（个/μL）	1 309.5（1 217.3， 1 397.5）	1 368.0（1 309.8， 1 423.5）	1 135.0（1 035.5， 1 214.5）	12 090.5	< 0.01
CD3⁺CD19 ^- T细胞/%	68（58， 76）	68（56， 78）	68（61， 75）	6 090.5	0.99
CD3 ^- CD19⁺B细胞计数（x ± s）/（个/μL）	309.65 ± 26.48	320.2 ± 22.97	288.54 ± 19.56	10.997	< 0.01
CD3 ^- CD19⁺B细胞（x ± s）/%	21.29 ± 9.06	18.7 ± 8.12	26.46 ± 8.67	-6.593	< 0.01
CD4⁺T细胞计数（x ± s）/（个/μL）	343.88 ± 42.71	363.16 ± 31.93	305.32 ± 34.76	12.324	< 0.01
CD4⁺T cell（x ± s）/%	34.02 ± 10.96	33.83 ± 11.35	34.4 ± 10.18	-0.384	0.7
CD8⁺T细胞计数（x ± s）/（个/μL）	1 041.31 ± 112.1	1 046.38 ± 101.37	1 031.18 ± 131.1	0.898	0.37
CD8⁺T细胞/ %	34（27， 39）	32（26， 37）	38（33， 41）	3713	< 0.01
CD3 ^- /CD16⁺ CD56⁺ NK细胞计数/（个/μL）	404.5（256.3， 447.0）	434.0（404.8， 455.0）	245.5（227.5， 256）.0	12 168	< 0.01
CD3 ^- /CD16⁺ CD56⁺ NK细胞/%	9（7， 12）	11（9， 13）	7（5， 8）	10 655	< 0.01
CD4⁺/CD8⁺比例	10（0.7， 1.5）	1.3（0.9， 1.8）	0.7（0.5， 0.9）	9 776	< 0.01
血清IgG（x ± s）/（g/L）	3.96 ± 1.55	4 ± 1.48	3.89 ± 1.69	0.506	0.61
血清IgM（x ± s）/（g/L）	1.31（0.94， 1.67）	1.27（0.87， 1.61）	1.47（1.11， 1.91）	4 825.5	< 0.01
血清IgA（x ± s）/（g/L）	2.50 ± 0.60	2.54 ± 0.60	2.42 ± 0.59	1.461	0.15
血清IgE/（IU/mL）	49.95（34.40， 68.83）	50.85（35.67， 66.50）	46.75（31.47， 76.07）	6 072.5	0.98

Tab.1

Tab. 2

Tab.3

Fig.1

Tab.4

Tab.5

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指标	CD3⁺CD19 ^- T细胞计数	CD4⁺T细胞计数	CD3 ^- CD19⁺B细胞计数	CD3 ^- /CD16⁺ CD56⁺ NK细胞计数
铁蛋白	-0.70	-0.75	-0.74	-0.76
LDH	-0.75	-0.73	-0.77	-0.73
CRP	-0.75	-0.80	-0.77	-0.76
D-D	-0.84	-0.83	-0.76	-0.73

变量	优势比（OR）	95%置信区间（CI）	P值
CD3?CD19?B 细胞计数	0.92	0.89 ~ 0.95	< 0.001
CD3?CD19?T 细胞计数	0.99	0.98 ~ 1.00	0.006
CD4?T 细胞计数	0.96	0.94 ~ 0.98	< 0.001
CD3?/CD16?CD56?NK 细胞计数	0.94	0.91 ~ 0.96	< 0.001

组别	例数	气道非黏液栓痰/［例（%）］	气道黏液栓痰/［例（%）］	淋巴细胞比例［M（P₂₅，P₇₅）］/%
普通MPP	14	12（85.71）	2（14.28）	0.13（0.09，0.18）
SMPP	30	12（40）	18（60）	0.11（0.08，0.19）
χ²值		6.308		0.04
P值		0.012		0.95

项目	黏液栓痰组（n = 20）	非黏液栓痰组（n = 24）	t/Z值	P值
CD3?CD19?T绝对数［M（P₂₅，P₇₅）］/（cells/μL）	1 050（900，1 200）	1 350（1 250，1 450）	2.78	0.006
CD3?CD19?T百分比/%	65.5 ± 8.2	68.3 ± 7.5	1.12	0.270
CD4?T绝对数/（cells/μL）	290 ± 40	360 ± 35	3.45	0.001
CD4?T百分比/%	32.1 ± 6.5	34.8 ± 5.9	1.49	0.143
CD8?T绝对数/（cells/μL）	980 ± 120	1040 ± 110	1.76	0.085
CD8?T百分比［M（P₂₅，P₇₅）］/%	38.5（34.2，42.0）	33.0（29.5，37.5）	2.15	0.032
CD4?/CD8?比值	0.7 ± 0.2	1.1 ± 0.3	4.12	< 0.001

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Phenotypic characteristics of early lymphocyte subsets and bronchoscopy findings in children with severe Mycoplasma pneumoniae pneumonia

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