The Effects Of Costimulatory Molecule OX40/OX40L On The Pathogenesis Of Refractory Mycoplasma Pneumonia In Children In Serum And Bronchoalveolar Lavage Fluid

Objective: To analyze the level of OX40 / OX40 L in serum and bronchoalveolar lavage fluid(BALF)of children with Refractory Mycoplasma pneumoniae pneumonia(RMPP)and the relationship between it and the severity of RMPP,so as to provide basis for early recognition,efficacy evaluation and prognostic judgement of RMPP,and observe the specific manifestations of RMPP under bronchoscope.Method: The children with Mycoplasma Pneumoniae Pneumonia(MPP)who were admitted in pediatrics of Inner Mongolia People’s Hospital from October 2018 to January 2020 were selected.The serum mycoplasma pneumonia specific Ig M antibody(MP-Ig M)of all the children was positive and the MP-DNA was positive by PCR.Children in the MPP group was divided into of general Mycoplasma pneumoniae(GMPP)group(30 cases)and Refractory Mycoplasma pneumoniae(RMPP)group(30 cases).The control group included a total of 20 children who underwent bronchial foreign body removal at the same time.The serum and BALF in the experimental group were collected in the acute and recovery phase.Enzyme-linked immunosorbent assay(ELISA)was used to determine the level of OX40 / OX40 L in the serum and BALF of GMPP group,RMPP group and control group and the correlation analysis was carried out.The tracheoscopic characteristics between GMPP group and RMPP group was compared.Result:1.The level of OX40 / OX40L(417.86 ± 152.21 pg / ml,539.17 ± 106.27 pg / ml)in the serum and BALF of the RMPP group was significantly higher than that in the GMPP group(303.73 ± 178.58 pg / ml,416.47 ± 162.47 pg / ml)and the control group(64.38 ± 22.57 pg / ml,105.67 ± 16.15 pg / ml),and the difference was statistically significant(P < 0.05).2.In terms of RMPP group,the level of OX40 / OX40L(417.86 ± 152.21 pg / ml,539.17 ± 106.27 pg / ml)in serum and BALF during acute phase was higher than that during recovery phase(88.79 ± 44.68 pg / ml,234.14 ± 100.2 pg / ml),and the difference was statistically significant(P < 0.05).3.In terms of GMPP group,the level of OX40 / OX40L(303.73 ± 178.58 pg / ml,416.47 ± 162.47 pg / ml)in serum and BALF during acute phase was higher than that during recovery phase(84.55 ± 32.44 pg / ml,198.98 ± 82.09 pg / ml),and the difference was statistically significant(P < 0.05).4.There was no significant difference between the level of OX40 / OX40L(88.79 ± 44.68pg/ml,234.14 ± 100.2pg / ml)in serum and BALF of RMPP group and that in GMPP group during recovery phase(84.55 ± 32.44pg/ml,198.98 ± 82.09 pg / ml)(P > 0.05).5.There was a significant positive correlation between OX40 / OX40 L level in serum of RMPP group and that in BALF of RMPP group(r = 0.989,P < 0.001).There was a significant positive correlation between OX40 / OX40 L in serum of GMPP and that in BALF of GMPP group during acute phase(r = 0.944,P < 0.001).6.Compared with GMPP group,children in the RMPP group were more likely to suffer from tracheobronchial stenosis and poor ventilation under electronic bronchoscopy,and the difference was statistically significant(P < 0.05).Conclusion:1.The expression of OX40 / OX40 L in the serum and BALF of RMPP and GMPP during acute phase was increased.Among them,the expression level of OX40 / OX40 L in RMPP group was significantly higher than that in GMPP group during acute phase,the expression level of OX40 / OX40 L during recovery phase was significantly lower than that during acute phase.During acute phase,there was a significant positive correlation between OX40 / OX40 L level in the serum and that in BALF during acute phase.OX40 / OX40 L play a promotive role in the pathogenesis of MPP.By detecting the level of OX40 / OX40 L in serum and BALF,the occurrence of rmpp can be recognized and predicted in the early stage.2.The bronchoscopic manifestations of GMPP are usually endobronchial inflammation.In addition to endobronchial inflammation,children in the RMPP group were more likely to suffer from tracheobronchial stenosis and poor ventilation than GMPP.The bronchoscopic manifestations of RMPP are more severe,which can better identify RMPP.In the early stage of the disease,timely interventional therapy through bronchoscope can improve the course of RMPP according to the clinical needs.