肺炎支原体腺病毒及甲型乙型流感病毒感染 住院患儿临床特征及细胞因子表达差异

Clinical Characteristics and Differences in Cytokine Expression in Hospitalized Children with Pneumonia Mycoplasma Adenovirus and Influenza A/B Viral Infections

摘要: 目的：探究苏州地区肺炎支原体(Mycoplasma pneumoniae, MP)、腺病毒(Adenovirus, ADV)及甲型乙型流感病毒(Influenza A/B, INFA/B)感染住院患儿临床特征及细胞因子表达差异，探讨细胞因子在三种呼吸道感染性疾病患儿中的诊断价值。方法：回顾性分析。收集2023年6月至2025年3月在苏州大学附属儿童医院住院的呼吸道感染患儿临床资料，根据十三项呼吸道病原体核酸结果将患儿分为MP患儿组、ADV患儿组及INFA/B患儿组，选取健康体检者为对照组，收集所有研究对象临床信息、生化检验结果及流式细胞因子结果，采用One-way ANOVA或非参数检验进行差异分析，采用受试者工作曲线(Receiver operating characteristic, ROC)评价细胞因子在诊断三组患儿中的价值。结果：相比于健康对照组，MP患儿组IL-4、IL-6、IL-8、IL-10水平升高，IL-1β、IL-5水平下降(P < 0.05)，ADV患儿组IL-4、IL-6、IL-8、IL-10、IFN-γ水平升高(P < 0.05)，IL-5水平下降，INFA/B患儿组IL-6、IL-8、IL-10水平升高，IL-5水平下降(P < 0.05)。三组患儿比较结果显示，ADV患儿组IL-1β、IL-6、IL-10、TNF-α、IFNα、IFN-γ高于MP患儿组，且IL-1β、IL-4、IFN-γ水平高于IFNA/B患儿组，差异均有统计学意义(P < 0.05)。ROC曲线结果显示MP患儿组IL-1β、IFN-α有较好诊断意义；ADV患儿组IL-10、IFN-α、IFN-γ有较好诊断意义；INFA/B患儿组IFN-γ有较好的诊断意义。结论：苏州地区MP、ADV及INFA/B感染住院患儿几乎存在咳嗽、发热、肺部影像学及肝肾功能损害现象，不同病原体感染患儿呈现程度及概率有所差异。不同呼吸道病毒感染患儿细胞因子水平有不同程度改变，炎症因子对于三种呼吸道感染有较好的诊断价值，MP患儿组IL-1β、IFN-α有较好诊断意义；ADV患儿组IL-10、IFN-α、IFN-γ有较好诊断意义；INFA/B患儿组IFN-γ有较好的诊断意义。

Abstract: Objective: To investigate the clinical characteristics and cytokine expression differences of Mycoplasma pneumoniae, adenovirus and influenza A and B infection in children hospitalized in Suzhou area, and to explore the diagnostic value of cytokines in children with three kinds of respiratory tract infections. Methods: This study was a retrospective analysis. Clinical data of children with respiratory tract infection hospitalized in the Children’s Hospital of Soochow University from June 2023 to March 2025 were collected. According to the results of nucleic acid test of 13 respiratory pathogens, the children divided into Mycoplasma pneumoniae group (MP), adenovirus group (ADV) and influenza A/B group (INFA/B), and healthy physical examinees were selected as control group. Clinical information, biochemical examination results and flow cytometry cytokine results of all subjects were collected. One-way ANOVA or non-parametric test was used for difference analysis, and receiver operating characteristic (ROC) curve was used to evaluate the value of cytokines in the of the three groups of children. Results: Compared with the healthy control group, the levels of IL-4, IL-6, IL-8, and IL-10 were elevated, and the levels of IL-1β and IL-5 were decreased in the MP group (P < 0.05). The levels of IL-4, -6, IL-8, IL-10, and IFN-γ were increased in the ADV group (P < 0.05), and the of IL-5 was decreased. The levels of IL-6, IL-8, and IL-10 were increased and the level of IL-5 was decreased in the INFA/B group (P < 0.05). The results of comparison among the three groups of children showed that the levels of IL-1β, IL-6, IL-10, TNF-α, IFNα, and IFN-γ were higher in the ADV group than in the MP group, and the levels of-1β, IL-4, and IFN-γ were higher in the ADV group than in the INFA/B group, with statistically significant differences (P < 0.05). The ROC curve results showed that IL-1β and IFN-α in the MP group had better diagnostic significance; IL-10, IFN-α, and IFN-γ in the ADV group had better diagnostic significance; and IFN-γ in the INFA/B group had better diagnostic significance. Conclusion: Children hospitalized with MP, ADV and INFA/B infection in Suzhou area almost had cough, fever, lung imaging and liver kidney function damage. The degree and probability of children with different pathogens infection showed some differences. Children with different respiratory virus infection had different degrees of changes in cytokines levels. Inflammatory factors had good diagnostic value for the three respiratory infections, IL-1β and IFN-α had good diagnostic significance in children with MP; IL-10, IFN-α and IFN-γ had good diagnostic significance in children with ADV; IFN-γ had good diagnostic significance in children with INFA/B.