肺炎支原体合并EB病毒感染的临床研究及免疫分析

发布时间：2018-03-13 05:06

本文选题：肺炎支原体　切入点：EB病毒　出处：《大连医科大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：目前肺炎支原体(Mycoplasma pneumoniae MP)合并EB (Epstein-Barr)病毒感染在临床中非常普遍，其临床表现较单纯支原体感染引起的肺部及肺外损伤重，免疫学发病机制在支原体肺炎（Mycoplasma pneumonia MPP）的发生、发展中所起到的作用越来越受到重视。本文旨在研究支原体肺炎、EB病毒感染、肺炎支原体合并EB病毒感染的临床特点，并进一步探讨支原体肺炎的免疫状态及支原体感染与EB病毒感染的相互关系，进而选择合理的肺炎支原体合并EB病毒感染的治疗方案。方法：随机选择大连医科大学附属二院儿科病房2011年1月-2012年1月收治的单纯EB病毒感染患儿37例，并随机选择同期收治的支气管肺炎患儿中单纯支原体感染患儿36例及肺炎支原体合并EB病毒感染患儿32例。对3组患儿血常规、肝功能、心肌酶谱、肺部影像学改变及尿常规等实验室检查结果进行回顾性统计、分析。另随机选择21例支原体肺炎（单纯支原体感染）患儿，采用流式细胞学方法检测T细胞亚群CD~(4+)、CD~(8+)及CD~(4+)/CD~(8+)比值与健康儿童比较，并通过ELISA法检测以上支原体肺炎患儿血清白细胞介素-6（interleukin-6，IL-6）水平并与健康儿童比较。健康对照组为同期我院儿科门诊正常体检的儿童，，近2个月内无感染性疾病史，无器质性疾病。所有儿童采血前均未使用干扰素、免疫球蛋白或输血等。结果：1.2011年1月-2012年1月我院儿科病房共收治支气管肺炎989例，符合支原体肺炎诊断标准者265例，支原体发病率为26.79%。 2.支原体肺炎及MP合并EB病毒感染患儿发病率均以学龄期偏高。 3.MP合并EB病毒感染患儿ALT异常率、导致肺部大叶实变几率及尿常规异常率均高于单纯MP及单纯EB病毒感染患儿，混合感染后粒细胞减低比率偏高于单纯EB病毒感染患儿，而与单纯支原体感染组比较无显著差异。混合感染后CK-MB异常率偏高于单纯MP感染患儿。而与单纯EB病毒感染患儿比较并未显著升高。 4.支原体肺炎患儿与健康对照组儿童比较CD4比例明显降低，CD8比例明显升高，CD4/CD8比值明显倒置，具有显著统计学意义（P0.01）。 5.支原体肺炎患儿血清IL-6浓度较健康对照组儿童明显升高，差异有显著统计学意义(P0.01)。结论： 1.肺炎支原体合并EB病毒感染患儿较单纯支原体或单纯EB病毒感染患儿肺部感染重，肺外并发症多。 2.支原体肺炎患儿CD4、CD8比例倒置，提示存在细胞免疫紊乱。 3.支原体肺炎患儿血清IL-6偏高于健康儿童，支原体感染可通过诱导机体分泌IL-6而造成对组织的损伤，故IL-6的检测对支原体肺炎的诊断及对评估病情具有重要意义。 4.肺炎支原体、EB病毒感染机体后对机体造成的损伤往往是由免疫反应导致的，因此抗支原体治疗及抗EB病毒治疗效果不佳时免疫调节治疗往往能取得较好的效果。
[Abstract]:Objective: Mycoplasma pneumoniae (pneumoniae) combined with Epstein-Barr) virus infection is very common in clinical practice, and its clinical manifestation is more serious than that caused by mycoplasma pneumoniae infection. The pathogenesis of immunology is Mycoplasma pneumonia MPP. The purpose of this paper is to study the clinical characteristics of Epstein-Barr virus infection of Mycoplasma pneumoniae, mycoplasma pneumoniae and Epstein-Barr virus infection. The immune status of mycoplasma pneumoniae and the relationship between mycoplasma infection and EB virus infection were further discussed, and the rational treatment scheme of mycoplasma pneumoniae combined with EB virus infection was selected. Methods: a total of 37 children with EBV infection were randomly selected from pediatric ward of the second affiliated Hospital of Dalian Medical University from January 2011 to January 2012. 36 cases of mycoplasma pneumoniae and 32 cases of Epstein-Barr virus (EBV) infection were randomly selected from 36 children with bronchopneumonia and 32 children with EBV infection. The results of laboratory examinations such as pulmonary imaging and urine routine were retrospectively analyzed. 21 children with mycoplasma pneumonia (mycoplasma simplex infection) were randomly selected. The ratio of T cell subsets (CD~(4 / CDF8) and CD~(4 / CDN (8) was detected by flow cytometry in comparison with that in healthy children. The serum levels of interleukin-6 interleukin-6 (IL-6) in children with mycoplasma pneumoniae were detected by ELISA method and compared with those in healthy children. The healthy control group was a normal check-up child in pediatric outpatient clinic of our hospital in the same period. There was no history of infectious disease in the last 2 months. No organic diseases. No interferon, immunoglobulin or blood transfusion were used before blood collection in all children. Results: 1. From January to January 2012, a total of 989 cases of bronchopneumonia were treated in our hospital, 265 cases met the diagnostic criteria of mycoplasma pneumonia, and the incidence of mycoplasma was 26.79. 2. The incidence of mycoplasma pneumonia and MP with Epstein-Barr virus infection was higher in school age. 3. The abnormal rate of ALT in children with Epstein-Barr virus infection was higher than that in children with simple MP and EBV infection, and the rate of granulocyte reduction was higher than that in patients with EBV infection. 3. The abnormal rate of ALT in children with Epstein-Barr virus infection was higher than that in children with simple EB virus infection. The abnormal rate of CK-MB after mixed infection was higher than that of simple MP infection, but not significantly higher than that of simple Epstein-Barr virus infection. 4.Compared with the healthy control group, the ratio of CD4 to CD8 was significantly decreased and the ratio of CD4 / CD8 was significantly reversed, which had significant statistical significance (P 0.01). 5. The concentration of serum IL-6 in children with mycoplasma pneumonia was significantly higher than that in healthy children (P 0.01). Conclusion:. 1. The pulmonary infection of mycoplasma pneumoniae with Epstein-Barr virus infection was more serious than that of simple mycoplasma pneumoniae and Epstein-Barr virus infection. 2. The percentage of CD _ 4 and CD _ 8 was reversed in children with mycoplasma pneumonia, indicating that there was cellular immune disorder. 3. The serum IL-6 of children with mycoplasma pneumonia is higher than that of healthy children. Mycoplasma infection can cause tissue damage by inducing the secretion of IL-6. Therefore, the detection of IL-6 is of great significance in the diagnosis and evaluation of mycoplasma pneumonia. 4. The damage caused by Epstein-Barr virus (EBV) infection is usually caused by immune reaction, so immunomodulatory therapy can get better effect when the effect of anti-mycoplasma and anti-EBV is not good.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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