目的：研究预测难治性儿童肺炎支原体肺炎的生物标志物。方法：回顾性分析本院2017年1月～2020年6月间收治的支原体肺炎患儿资料，从中选取37例儿童难治性支原体肺炎（RMPP）患儿纳入RMPP组，从中另选取37例儿童普通支原体肺炎（MPP）患儿纳入MPP组，对比两组患儿入院时的生物标志物：白细胞计数（WBC）、中性粒细胞百分比、C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素-6（IL-6）、白细胞介素18（IL-18）、乳酸脱氢酶、铁蛋白（SF）、D-二聚体（D-D）表达水平的差异性，以Logistic分析RMPP的预测因素，以受试者工作特征（ROC）曲线的各项预测因素的预测阈值。结果：两组患儿一般资料无统计学差异（P>0.05）；两组患儿WBC、中性粒细胞百分比、PCT水平均无统计学差异（P>0.05）；RMPP组患儿CRP、IL-6、IL-18、乳酸脱氢酶、SF、D-D水平均高于MPP组患儿；IL-6、IL-18、乳酸脱氢酶、SF、D-D为儿童RMPP的独立预测因素（P<0.05）；患儿血清IL-6、SF对儿童RMPP具有较高预测价值（P<0.05），IL-18、乳酸脱氢酶、D-D水平具有中等预测价值（P<0.05）；IL-6预测阈值为7.105pg/ml，IL-18为164.950ng/ml，乳酸脱氢酶为358.300IU/L，SF为166.860μg/L，D-D为1.105μg/L。结论：检测上述各项预测因素水平可为难治性儿童支原体肺炎预判提供科学性参考，入院后检测上述各项预测因素水平能够为后续治疗方案的选择提供必要支持。

Objective: To study biomarkers for the prediction of intractable mycoplasma pneumoniae pneumonia in children. Methods: a retrospective analysis of our hospital from January 2017 to June 2020 were mycoplasma pneumonia in children with material, selected from 37 cases of refractory mycoplasma pneumonia in children (RMPP) children into the RMPP group, from which the other 37 cases selected children's normal children with mycoplasma pneumonia (MPP) into the MPP group, compared two groups of children with biomarkers on admission to hospital: White blood cell count (WBC), neutrophil percentage, c-reactive protein (CRP), calcitonin (PCT) and interleukin 6 (IL-6) and interleukin 18 (IL-18), lactate dehydrogenase, ferritin (SF), D-dimer(D-D), the difference of the expression level in Logistic analysis RMPP predictors, under the receiver-operating characteristic (ROC) curve of predictors prediction threshold. Results: there was no statistical difference in general information between the two groups (P>0.05). There were no statistically significant differences in WBC, neutrophil percentage and PCT levels between the two groups (P>0.05). CRP, IL-6, IL-18, lactate dehydrogenase, SF and D-D in RMPP group were all higher than those in MPP group. IL-6, IL-18, lactate dehydrogenase, SF and D-D were independent predictors of RMPP in children (P<0.05). Serum IL-6 and SF had high predictive value for RMPP in children (P<0.05), while il-18, lactate dehydrogenase and D-D had moderate predictive value (P<0.05). The predicted thresholds for IL-6 were 7.105pg/ mL, 164.950ng/ml for IL-18, 358.300IU/L for lactate dehydrogenase, 166.860 g/L for SF, and 1.105 g/L for D-D. Conclusion: The detection of these predictive factors can provide scientific reference for the prediction of refractory mycoplasma pneumonia in children, and the detection of these predictive factors after admission can provide necessary support for the selection of follow-up treatment.

海南省卫生计生行业科研项目,编号:16A200012