不同类型肺炎支原体肺炎儿童血浆凝血酶调节蛋白和D-二聚体的变化

Changes in plasma levels of thrombomodulin and D-dimer in children with different types of Mycoplasma pneumoniae pneumonia

摘要:

目的：探讨不同类型肺炎支原体肺炎（MPP）儿童血浆凝血酶调节蛋白（TM）和D-二聚体（D-D）的变化及其在儿童MPP发病机制中的作用。方法：52例MPP患儿，其中表现为大叶性肺炎者30例作为大叶性肺炎组，表现为间质性肺炎者22例作为间质肺炎组；30例健康儿童作为对照组。分别采用酶联免疫吸附法、乳胶增强免疫比浊法测定血浆TM和D-D水平。结果：大叶性肺炎组、间质性肺炎组、对照组血浆TM水平（中位数）分别为23.83、15.56、8.78μg/L，3组比较差异有统计学意义（P<0.01），其中大叶性肺炎组和间质性肺炎组血浆TM水平均明显高于对照组（P<0.01），且大叶性肺炎组血浆TM水平高于间质性肺炎组（P<0.05）。大叶性肺炎组和间质性肺炎组血浆D-D水平（中位数）均明显高于参考值中位数（P<0.01）；大叶性肺炎组血浆D-D水平明显高于间质性肺炎组（0.35μg/mL vs 0.13 μg/mL, P<0.01），且大叶性肺炎组血浆D-D升高比例明显高于间质性肺炎组（87% vs 59%，P<0.05）。结论：血浆TM 和D-D水平在MPP患儿中存在不同程度升高，表现为大叶性肺炎者升高更明显，提示血管内皮细胞损伤和血液高凝状态参与了MPP的发病机制。

Abstract:

OBJECTIVE: To investigate the changes in plasma levels of thrombomodulin (TM) and D-dimer (DD) in children with different types of Mycoplasma pneumoniae pneumonia (MPP), and their role in the pathogenesis of MPP in children. METHODS: Fifty-two children with MMP were divided into lobar pneumonia (n=30) and interstitial pneumonia groups (n=22) and another 30 healthy children were selected as the control group. Plasma levels of TM and D-D were measured using enzyme-linked immunosorbent assay and latex-enhanced immunoturbidimetric assay, respectively. RESULTS: The lobar pneumonia, interstitial pneumonia and control groups had median plasma TM levels of 23.83, 15.56 and 8.78 μg/L respectively, with significant differences between the three groups (P<0.01). The lobar pneumonia and interstitial pneumonia groups had significantly higher plasma TM levels than the control group (P<0.01), and the lobar pneumonia group had a significantly higher plasma TM level than the interstitial pneumonia group (P<0.05). Median plasma D-D levels in the lobar pneumonia and interstitial pneumonia groups were significantly higher than the reference value (P<0.01). The lobar pneumonia group had a significantly higher plasma D-D level than the interstitial pneumonia group (0.35 μg/mL vs 0.13 μg/mL; P<0.01), and the percentage of patients with elevated plasma D-D levels was significantly higher in the lobar pneumonia group than in the interstitial pneumonia group (87％vs 59％; P<0.05). CONCLUSIONS: Children with MPP, especially those with lobar pneumonia, have increased plasma levels of TM and D-D. This suggests that damage to vascular endothelial cells and blood hypercoagulability may be involved in the pathogenesis of MPP.