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目的:探讨儿童重症肺炎支原体肺炎(MPP)激素治疗前后IL-12P40,IL-18,sIL-2R动态变化及意义。方法:2009年6月～2011年6月,该院呼吸科住院患者重症MPP40例。使用ELISA方法对重症MPP激素治疗前后的IL-12P40,IL-18,sIL-2R进行测定,并与普通MPP患者相比较,以了解免疫机制在重症MPP中的参与作用。结果:①重症MPP激素治疗后IL-12P40,IL-18,sIL-2R的水平较治疗前明显下降,差异有统计学意义(P<0.05)。②重症MPP在激素治疗后IL-12P40水平较普通MPP者明显下降,差异有统计学意义(P<0.05),而激素治疗前与普通MPP者之间差异无统计学意义(P>0.05)。③IL-18和sIL-2R在重症MPP激素治疗前与普通MPP相比明显升高,差异有统计学意义(P<0.05)。结论:重症MPP中TH1反应占优势,过度细胞免疫反应引起全身性的免疫的损伤,造成相应临床症状。IL-18及sIL-2R发挥了重要的介导作用,而IL-12P40并未参与。激素治疗主要通过抑制机体的细胞免疫反应,减少全身包括肺部的炎症的损伤,缓解临床症状,减少肺部后遗症的发生。
Objective: To investigate the dynamic changes of IL-12P40, IL-18 and sIL-2R in children with severe Mycoplasma pneumoniae pneumonia (MPP) before and after hormone therapy. Methods: From June 2009 to June 2011, 40 hospitalized patients with severe MPP in the department of respiratory medicine were enrolled. The levels of IL-12P40, IL-18 and sIL-2R in severe MPP before and after treatment were measured by ELISA and compared with those of ordinary MPP in order to understand the role of immune mechanism in severe MPP. Results: ① The levels of IL-12P40, IL-18 and sIL-2R in severe MPP were significantly lower than those before treatment, the difference was statistically significant (P <0.05). (2) The level of IL-12P40 in severe MPP was significantly lower than that of ordinary MPP after hormone therapy, the difference was statistically significant (P <0.05), but there was no significant difference between before and after hormone therapy (P> 0.05). ③ The levels of IL-18 and sIL-2R in severe MPP before treatment were significantly higher than those in normal MPP, the difference was statistically significant (P <0.05). CONCLUSIONS: The TH1 response predominates in severe MPP, and over-cellular immune response causes systemic immune damage resulting in the corresponding clinical symptoms. IL-18 and sIL-2R play an important mediator, while IL-12P40 is not involved. Hormone therapy mainly through the inhibition of the body’s cellular immune response, reduce inflammation in the body, including lung injury, relieve clinical symptoms, reduce lung sequelae.