Study Of Serum Cytokines Expression Of T Cell Subsets With Mycoplasma Pneumoniae Pneumonia In Children

Objective : Mycoplasma pneumoniae pneumonia(MPP)is one of the major community-acquired pneumonia at present,the incidence has a tendency to increase in recent years.In recent years,refractory mycoplasma pneumoniae pneumonia(RMPP)increase gradually,difficult to identify early,makes more troubles for the later treatment.Refractory mycoplasma pneumoniae pneumonia involves in other systems easily,or even causes multiple organ dysfunction.At present,about the pathogenesis of the MPP and developing to RMPP is unclear,the majority view is mainly related to the body's immune function disorder.T cells play an important regulating role in the body's immune response,the purpose of this study was to explore T cell subsets and its related factors on the pathogenesis of MPP and RMPP.This study may provide theoretical basis for clinical diagnosis,treatment,and improve the cure rate,prevent serious complications.Methods:232 cases diagnosed of mycoplasma pneumoniae pneumonia in children were admitted from pediatrics department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital during August 2015 and January 2015.We used enzyme-linked immunosorbent assay(ELISA)to detection the levels of serum IL-4,IFN-r,IL-17,IL-23,IL-10,IL-9.The study was divided into two parts :(1)According to the age232 cases were divided into groups of infant,preschool and school-age;According to the presence of wheeze into the non-wheeze group,the wheeze group(the first wheeze group and more wheeze group),to explore the role of T cell subsets and related cytokines in the immunological pathogenesis of MPP and with wheeze in different age children.(2)232 cases were MPP and RMPP cases,then,according to the presence of wheeze into the non-wheeze group,the wheeze group(the first wheeze group and more wheeze group),to explore the role of T cell subsets and related cytokines in the immunological pathogenesis of RMPP and with wheeze in different age children.Results:(1)In the 232 cases with MPP,preschool and school-age children accounted for 78%,infant children accounted for 22%;Among them,the rate of wheeze in infant stage was 69.2%,in preschool stage 52.4%,in school-age stage 43.8%.(2)Levels of serum IL-10 in infant with MPP were significantly higher than preschool and school-age children(P<0.05),while no significant differences between preschool andschool-age;Levels of serum IL-4,IFN-r,IFN-r/IL-4,IL-17,IL-23,IL-9 has no significant statistical differences(P > 0.05).(3)Levels of serum IL-4,IL-23,IL-10 increased obviously,and IFN-r/IL-4,IL-9 significantly decreased in children with MPP with wheeze(P < 0.05);Levels of serum IL-4,IL-10 increased significantly and IL-9 significantly decreased in children with MPP with first wheeze and more wheeze compared to non-wheeze group(P < 0.05).While levels of serum cytokines between first wheeze and more wheeze group has no significant statistical difference(P > 0.05).(4)Levels of serum IL-23,IL-10 in infant with MPP with wheeze increased obviously(P < 0.05);Levels of serum IL-4 in preschool with MPP with wheeze increased obviously(P < 0.05),and IFN-r/IL-4,IL-9 significantly decreased(P < 0.05);Levels of serum IL-4 in school-age with MPP with wheeze increased obviously(P <0.05),and IFN-r/IL-4,IL-17,IL-9 significantly decreased(P < 0.05).(5)Levels of serum IL-4 in preshcool and school-age with MPP with first wheeze increased obviously than in infant(P < 0.05),and IL-10 significantly decreased(P < 0.05);Levels of serum IL-10,IL-17 in preshcool and school-age with MPP with more wheeze significantly decreased than in infant(P < 0.05);Levels of serum cytokines has no significant statistical differences between preshcool and school-age(P > 0.05).(6)MPP and RMPP is given priority to with preschool and school-age children,but the proportion of infants in RMPP increased(28%);MPP and RMPP in children with wheeze occupies certain proportion(35%,66%),RMPP with wheeze occurs obvious rise.(7)Levels of serum IL-4,IFN-r,IFN-r/IL-4,IL-23,IL-10 increased obviously,and IL-9 significantly decreased in children with RMPP(P < 0.05);Other,levels of IL-17 has no significant statistical difference(P > 0.05).(8)Compared to MPP,levels of serum IL-23 and IFN-r/IL-4 increased obviously in infant with RMPP(P < 0.05);Levels of serum IFN-r,IL-23,IL-10 and IFN-r/IL-4 increased obviously in preschool(P< 0.05);levels of serum IL-4,IFN-r,IL-23,IL-10 and IFN-r/IL-4 increased obviously and IL-9 significantly decreased in school-age(P < 0.05).(9)Levels of serum IFN-r significantly decreased only in children with MPP with wheeze(P < 0.05);Levels of serum IL-4,IL-10 increased obviously,and IFN-r,IFN-r/IL-4,IL-9 significantly decreased in children with RMPP with wheeze(P < 0.05).(10)Levels of serum IL-4increased obviously,and IFN-r,IFN-r/IL-4 significantly decreased in children with RMPP with first wheeze;Levels of serum IL-10 increased obviously,and IFN-r,IFN-r/IL-4 significantly decreased in children with RMPP with more wheeze compared to the non-wheeze group(P < 0.05).(11)Levels of serum IFN-r,IFN-r/IL-4increased obviously in children with non-wheeze,and IL-4,IFN-r,IL-23 significantly increased and IL-9 significantly decreased with first wheeze,and IL-10,IFN-rincreased obviously,and IL-9 significantly decreased with more wheeze compared to MPP((P < 0.05).Conclutions:(1)MPP in children is given priority to preschool and school-age,have a trend of younger age,MPP with wheeze in infant is significantly higher than preschool and school-age.(2)In MPP acute phase,the body's immune response in infant is of Treg cells mediated immunity,enhanced negative feedback regulation.MPP with wheeze occurs when there is imbalance of Th1 / Th2 cells,not only the imbalance of Treg /Th17 cells play an important role.The immune mechanism of MPP with wheeze in each age is different.The immune response of Th1 and Th2 cells in infant with wheeze is low,proinflammatory enhancement of Th17 cells also immunosuppression enhancement of Treg cells.Preschool and school-age children with MPP with wheeze except Th2 cellular immune advantage,Th17 cells,Treg cells and Th9 cells also play an important immune regulation.(3)The incidence of RMPP increased significantly in the total MPP children,see more at preschool and school-age children.Wheeze is more likely to occur in RMPP.The immune function of Th1 and Th2 cells in the process of occurrence and development in children with RMPP are enhanced,dominant at Th1 cells,at the same time,there are all kinds of cytokines of disorder,more prominent in the preschool and school-aged with RMPP.(4)RMPP with wheeze occur in the imbalance of Th1 / Th2 cells,more significantly in first wheeze children with RMPP.At the same time,there is the imbalance of Treg/Th17 cells,have more prominent in children with RMPP with more wheeze.