儿童支原体肺炎血及肺泡灌洗液中炎性指标水平及意义

发布时间：2018-01-18 09:53

本文关键词：儿童支原体肺炎血及肺泡灌洗液中炎性指标水平及意义　出处：《河北联合大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的1探讨儿童难治性肺炎支原体肺炎血白细胞、血沉、C-反应蛋白及支气管肺泡灌洗液中细胞因子白介素-6、白介素-10水平变化及其临床意义。2评价支气管镜检及支气管肺泡灌洗在儿童难治性肺炎支原体肺炎的应用价值。方法1选取唐山市妇幼保健院小儿呼吸科确诊为难治性肺炎支原体肺炎且接受支气管镜检及支气管肺泡灌洗的97例患儿为研究对象，，作为实验组；选取同期在该院耳鼻喉科住院的30例支气管异物患儿作为对照1组；选取同期在小儿呼吸科确诊为难治性肺炎支原体肺炎未接受支气管镜检查及支气管肺泡灌洗的30例患儿作为对照2组，选取同期确诊为普通肺炎支原体肺炎的100例患儿作为对照3组。2实验组及对照1组患儿进行支气管镜检查及支气管肺泡灌洗后，采用双抗体夹心ABC-酶联免疫吸附法检测其肺泡灌洗液中白介素-6、白介素-10水平；实验组和对照3组患儿均于入院当天（或次日清晨空腹）抽血，分别检测其血白细胞、血沉、C-反应蛋白水平；实验组及对照2组患儿同时抽血检测肺炎支原体抗体，其中肺炎支原体抗体检测采用明胶颗粒凝集试验；实验组患儿以支气管镜检术后治疗1周体温、咳嗽情况及肺部影像学改变，分显效、有效、无效作为术后疗效判断标准，与对照2组在常规治疗同疗程下进行疗效比较。结果1实验组BALF中白介素-6、白介素-10水平高于对照1组，差异有统计学意义（P0.05）。2实验组血中白细胞、血沉及C-反应蛋白水平均明显高于对照3组，差异有统计学意义（P0.05）。3实验组患儿常规治疗的同时经支气管镜检及支气管肺泡灌洗术后，平均热退时间为入院后第4.48天，平均咳嗽减轻时间为入院后第5.54天，且1周后复查肺CT肺部病灶大部分或基本吸收65例，疗效判断总有效率为98.1%；对照2组单用常规治疗同疗程，平均热退时间为入院后第9.33天，咳嗽减轻时间为入院后第10.40天，且1周后复查肺CT肺部病灶大部分或基本吸收13例，疗效判断总有效率为76.7%，实验组与对照2组患儿的疗效比较（P0.05），差异有统计学意义。结论1白介素-6和白介素-10在难治性肺炎支原体肺炎患儿支气管肺泡灌洗液中明显增高，提示其在感染后引起的细胞免疫功能紊乱中发挥着一定的作用，对于免疫调节治疗具有一定的指导意义。2儿童难治性肺炎支原体肺炎血白细胞、血沉、C-反应蛋白水平均有不同程度的升高，这些炎性指标的升高在一定程度上反映疾病的严重程度。3支气管镜检查及支气管肺泡灌洗可显著提高难治性肺炎支原体肺炎的治愈率，是治疗难治性肺炎支原体肺炎的重要手段。
[Abstract]:Objective 1 to investigate the relationship between leukocyte, erythrocyte sedimentation rate (ESR) and interleukin-6 (IL-6) in bronchoalveolar lavage fluid (BALF) in children with refractory mycoplasma pneumoniae pneumonia. Changes of Interleukin-10 level and its Clinical significance .2 to evaluate the value of bronchoscopy and bronchoalveolar lavage in children with refractory mycoplasma pneumoniae pneumonia. Methods 1 97 children with refractory mycoplasma pneumoniae pneumonia and bronchoalveolar lavage were selected as experimental group. 30 cases of bronchial foreign bodies hospitalized in the otolaryngology department of this hospital were selected as control group 1. Thirty children with refractory mycoplasma pneumoniae pneumonia diagnosed in respiratory department in the same period were selected as the control group, who were not examined by bronchoscopy and bronchoalveolar lavage. A total of 100 children with mycoplasma pneumoniae pneumonia were selected as control group (group .2) and control group (group 1) for bronchoscopy and bronchoalveolar lavage. The levels of interleukin-6 and interleukin-10 in alveolar lavage fluid were detected by double antibody sandwich ABC- enzyme linked immunosorbent assay. The patients in the experimental group and the control group were taken blood samples on the day of admission (or the next morning), and the levels of white blood cells and erythrocyte sedimentation rate (ESR) C-reactive protein were measured. Mycoplasma pneumoniae antibody was detected in both experimental group and control group, and gelatin particle agglutination test was used to detect mycoplasma pneumoniae antibody. The children in the experimental group were treated with bronchoscopy for 1 week after the treatment of body temperature, cough and pulmonary imaging changes, marked effect, effective, ineffective as the standard of postoperative curative effect. The therapeutic effect was compared with that of the control group under the same course of treatment. Results 1the levels of interleukin-6 and interleukin-10 in BALF in the experimental group were higher than those in the control group, and the difference was statistically significant (P 0.05). 2. The white blood cells in the experimental group were significantly higher than those in the control group. The levels of ESR and C-reactive protein were significantly higher than those of the control group (P 0.05.3). The children in the experimental group underwent bronchoscopy and bronchoalveolar lavage at the same time. The mean time of heat withdrawal was 4.48 days after admission, the average time of cough relief was 5.54 days after admission, and 65 cases of lung CT lung lesions were reexamined after one week. The total effective rate was 98.1. The average time of heat withdrawal was 9.33 days after admission and the time of cough relief was 10.40 days after admission. After 1 week, 13 cases of lung CT pulmonary lesions were reexamined, the total effective rate was 76.70.The curative effect of the experimental group and the control group was compared with that of the control group (P 0.05). The difference is statistically significant. Conclusion 1Interleukin-6 and interleukin-10 were significantly increased in bronchoalveolar lavage fluid of children with refractory mycoplasma pneumoniae pneumonia. It is suggested that it plays a certain role in the cellular immune dysfunction caused by infection, and has certain guiding significance for immunomodulation therapy. 2. Children with refractory mycoplasma pneumoniae pneumonia, blood white blood cells, erythrocyte sedimentation rate (ESR). The level of C-reactive protein increased in varying degrees. The elevation of these inflammatory markers to a certain extent reflects the severity of the disease. 3 bronchoscopy and bronchoalveolar lavage can significantly improve the cure rate of refractory mycoplasma pneumoniae pneumonia. It is an important method to treat refractory mycoplasma pneumoniae pneumonia.
【学位授予单位】：河北联合大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.6

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