α1-抗胰蛋白酶等与儿童肺炎支原体肺炎并发 塑型性支气管炎的相关性研究

Study on the Association of α1-Antitrypsin and Related Biomarkers with Plastic Bronchitis in Children with Mycoplasma pneumoniae Pneumonia

摘要: 目的：探讨α1-抗胰蛋白酶(α1-AT)、中性粒细胞弹性蛋白酶(NE)及炎症因子水平在儿童肺炎支原体肺炎(MPP)并发塑型性支气管炎(PB)中的临床意义，为儿童PB的早期诊疗提供新思路。方法：采用单中心回顾性队列研究，纳入139例MPP患儿，依据气道是否取出塑型物分为PB组(68例)与非PB组(71例)。收集患儿临床及影像学资料，收集患儿外周血、支气管肺泡灌洗液(BALF)，检测α1-AT、NE、中性粒细胞比例(Neutrophil proportion, Neut%)、白细胞介素6 (IL-6)、肿瘤坏死因子α (TNF-α)等指标。绘制受试者工作特征曲线(ROC曲线)评价诊断效能。通过Spearman相关系数分析α1-AT与其余指标的相关性。结果：PB组急性期α1-AT、NE、Neut%、IL-6、TNF-α水平均显著高于非PB组(p < 0.05)。治疗后，两组恢复期α1-AT水平较急性期均显著降低(p < 0.05)。α1-AT、NE、Neut%、IL-6、TNF-α对于MPP患儿是否并发PB均具有一定的预测价值，α1-AT诊断效能优于其它指标。PB组患儿入院时α1-AT与NE、Neut%呈正相关。结论：1) MPP并发PB患儿的炎症反应较MPP未并发PB患儿更为严重；2) α1-AT与其他炎症指标相结合，具有作为潜在诊断MPP并发PB辅助标志物的价值。

Abstract: Objective: To investigate the clinical significance of α1-antitrypsin (α1-AT), neutrophil elastase (NE), and inflammatory cytokines in plastic bronchitis (PB) in children with Mycoplasma pneumoniae pneumonia (MPP), and to provide new insights for the early diagnosis and management of PB. Methods: This single-center retrospective cohort study included 139 children diagnosed with MPP. Patients were divided into a PB group (n = 68) and a non-PB group (n = 71) according to the presence of bronchial casts removed from the airway. Clinical and imaging data were collected. Peripheral blood and bronchoalveolar lavage fluid (BALF) samples were collected to measure α1-AT, NE, neutrophil proportion (Neut%), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Receiver operating characteristic (ROC) curves were constructed to evaluate diagnostic performance. Spearman’s correlation analysis was used to assess the relationship between α1-AT and other indicators. Results: During the acute phase, levels of α1-AT, NE, Neut%, IL-6, and TNF-α in the PB group were significantly higher than those in the non-PB group (p < 0.05). After treatment, α1-AT levels in the recovery phase were significantly decreased compared with those in the acute phase in both groups (p < 0.05). α1-AT, NE, Neut%, IL-6, and TNF-α all demonstrated predictive value for the occurrence of PB in children with MPP, with α1-AT showing superior diagnostic performance compared to the other indicators. Furthermore, α1-AT levels on admission in the PB group were positively correlated with NE and Neut%. Conclusions: 1) Children with MPP complicated by PB exhibit a more severe inflammatory response than those without PB. 2) Combined assessment of α1-AT and other inflammatory indicators has the potential to serve as an auxiliary diagnostic marker for MPP-associated PB.