血清Clara细胞分泌蛋白16、肿瘤坏死因子-α、白介素-6、肺表面活性蛋白D在重症肺炎患儿中的水平变化

doi:10.3877/cma.j.issn.2095-655X.2021.03.012

目的

探讨血清Clara细胞分泌蛋白16(CC16)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、肺表面活性蛋白D(SP-D)在重症肺炎患儿中的水平变化。

方法

选取2018年3月至2020年3月枣庄市妇幼保健院儿科收治的肺炎患儿，分为重度组(n＝104)和轻度组(n＝100)，将同期健康体检儿童纳入健康组(n＝100)，检测3组患儿血清CC16、TNF-α、IL-6、SP-D水平，并分析重度组患儿采用呼吸机后1 h、72 h及撤机前(1 h内)呼吸力学参数指标，包括呼吸功(WOB)、气道阻力(Raw)、肺动态顺应性(Cdyn)、气道峰值吸气压力(PIP)。采用单因素方差分析比较3组患儿血清CC16、TNF-α、IL-6、SP-D水平；采用重复测量的方差分析比较重度组患儿采用呼吸机后不同时间点血清炎性因子的水平和呼吸力学参数指标；采用Pearson相关分析法分析重症组患儿血清CC16、TNF-α、IL-6、SP-D水平与呼吸力学参数指标的相关性。

结果

重度组患儿血清CC16、TNF-α、IL-6、SP-D水平依次为(11.15±2.36)μg/L、(57.88±9.93)ng/L、(60.46±9.55)ng/L、(97.53±9.38)μg/L；轻度组依次为(17.56±2.48)μg/L、(15.55±6.76)ng/L、(37.88±8.72)ng/L、(51.53±6.45)μg/L；健康组依次为(20.02±3.43)μg/L、(2.92±0.23)ng/L、(6.03±0.41)ng/L、(20.00±3.18)μg/L；重度组、轻度组、健康组血清TNF-α、IL-6、SP-D水平依次降低，血清CC16水平依次升高(F＝589.98，482.76，596.89，45.46；均P<0.05)。Pearson相关分析结果显示，血清CC16水平与WOB、Raw、PIP呈负相关(r＝-0.70，-0.70，-0.69；均P<0.05)；血清TNF-α、IL-6、SP-D水平分别与WOB、Raw、PIP呈正相关(r＝0.78，0.77，0.70，0.77，0.77，0.71，0.71，0.75，0.73；均P<0.05)；血清CC16水平与Cdyn呈正相关(r＝0.81，P<0.05)，血清TNF-α、IL-6、SP-D水平与Cdyn呈负相关(r＝-0.79，-0.80，-0.80；均P<0.05)。

结论

血清CC16、TNF-α、IL-6、SP-D水平与重症肺炎患儿疾病严重程度及呼吸功能存在一定的关系。

关键词: 肺炎，细菌性, Clara细胞分泌蛋白16, 肿瘤坏死因子-α, 白细胞介素-6, 肺表面活性蛋白D

Objective

To explore the changes of serum Clara cell secretory protein 16(CC16), tumor necrosis factor-α (TNF-α), interleukin-6(IL-6) and pulmonary surfactant protein D (SP-D) in children with severe pneumonia.

Methods

From March 2018 to March 2020, the children with pneumonia in Pediatrics Department of Maternity and Child Health Care Hospital of Zaozhuang were divided into severe group (n=104) and mild group (n=100). Meanwhile 100 healthy children were included into healthy group. Serum levels of CC16, TNF-α, IL-6, SP-D were detected in the three groups. Respiratory mechanical parameters including work of breathing (WOB), airway resistance (RAW), lung dynamic compliance (Cdyn), and peak inspiratory pressure (PIP) were analyzed in the severe group at 1h, 72 h after ventilator application and before withdrawal from the ventilator. The levels of serum CC16, TNF-α, IL-6 and SP-D in the three groups were compared by one-way analysis of variance. The levels of serum inflammatory factors and respiratory mechanical parameters in the severe group were compared at different time after ventilator application by repeated measurement analysis of variance. The correlation between the levels of serum CC16, TNF-α, IL-6, SP-D and respiratory mechanical parameters were analyzed by Pearson correlation analysis.

Results

The levels of serum CC16, TNF-α, IL-6 and SP-D in severe group were (11.15±2.36)μg/L, (57.88±9.93)ng/L, (60.46±9.55)ng/L and (97.53±9.38)μg/L, respectively, while levels in mild group were (17.56±2.48)μg/L, (15.55±6.76)ng/L, (37.88±8.72)ng/L and (51.53±6.45)μg/L. The healthy group were (20.02±3.43)μg/L, (2.92±0.23)ng/L, (6.03±0.41)ng/L, (20.00±3.18)μg/L. The serum TNF-α, IL-6 and SP-D levels in severe group, mild group and healthy group decreased in turn, while the levels of serum CC16 in the three groups increased in turn (F=589.98, 482.76, 596.89, 45.46, all P<0.05). Pearson analysis showed that serum CC16 level was negatively correlated with WOB, Raw and PIP (r=-0.70, -0.70, -0.69, all P<0.05), serum TNF-α, IL-6, SP-D levels were positively correlated with WOB, Raw and PIP (r=0.78, 0.77, 0.70, 0.77, 0.77, 0.71, 0.71, 0.75, 0.73, all P<0.05). Serum CC16 was positively correlated with Cdyn (r=0.81, P<0.05), serum TNF-α, IL-6, SP-D were negatively correlated with Cdyn (r=-0.79, -0.80, -0.80, all P<0.05).

Conclusion

The levels of serum CC16, TNF-α, IL-6 and SP-D are related to severity of disease and respiratory function of children with severe pneumonia.

Key words: Pneumonia, bacterial, Clara cell secretory protein 16, Tumor necrosis factor-α, Interleukin-6, Pulmonary surfactant protein D

表1 3组血清炎性因子水平比较(±s)

组别	例数	CC16(μg/L)	TNF-α(ng/L)	IL-6(ng/L)	SP-D(μg/L)
重度组	104	11.15±2.36	57.88±9.93	60.46±9.55	97.53±9.38
轻度组	100	17.56±2.48^a	15.55±6.76^a	37.88±8.72^a	51.53±6.45^a
健康组	100	20.02±3.43^ab	2.92±0.23^ab	6.03±0.41^ab	20.00±3.18^ab
F值		45.46	589.98	482.76	596.89
P值		<0.05	<0.05	<0.05	<0.05

表1 3组血清炎性因子水平比较(±s)

组别	例数	CC16(μg/L)	TNF-α(ng/L)	IL-6(ng/L)	SP-D(μg/L)
重度组	104	11.15±2.36	57.88±9.93	60.46±9.55	97.53±9.38
轻度组	100	17.56±2.48^a	15.55±6.76^a	37.88±8.72^a	51.53±6.45^a
健康组	100	20.02±3.43^ab	2.92±0.23^ab	6.03±0.41^ab	20.00±3.18^ab
F值		45.46	589.98	482.76	596.89
P值		<0.05	<0.05	<0.05	<0.05

表2 重度组患儿采用呼吸机后不同时间点血清炎性因子水平及呼吸力学参数指标的比较(n＝104，±s)

项目	上机后1 h	上机后72 h	撤机前(1 h内)	F值	P值
CC16(μg/L)	11.64±0.45	9.64±1.37^c	18.66±2.51^cd	49.53	<0.05
TNF-α(ng/L)	62.32±9.49	81.39±9.47^c	10.34±3.59^cd	281.28	<0.05
IL-6(ng/L)	87.03±9.69	99.84±9.72^c	13.54±5.17^cd	314.71	<0.05
SP-D(μg/L)	86.13±8.78	93.88±9.71^c	23.75±5.82^cd	227.15	<0.05
WOB(J/L)	1.76±0.31	1.19±0.27^c	0.64±0.23^cd	100.98	<0.05
Raw[cmH₂O/ (L·S)]	85.43±5.57	57.45±4.55^c	49.42±2.58^cd	309.64	<0.05
Cdyn(ml/cmH₂O)	3.73±0.75	4.48±0.51^c	5.39±0.79^cd	34.03	<0.05
PIP(cmH₂O)	28.73±1.45	24.28±1.51^c	21.19±1.49^cd	48.89	<0.05

表2 重度组患儿采用呼吸机后不同时间点血清炎性因子水平及呼吸力学参数指标的比较(n＝104，±s)

项目	上机后1 h	上机后72 h	撤机前(1 h内)	F值	P值
CC16(μg/L)	11.64±0.45	9.64±1.37^c	18.66±2.51^cd	49.53	<0.05
TNF-α(ng/L)	62.32±9.49	81.39±9.47^c	10.34±3.59^cd	281.28	<0.05
IL-6(ng/L)	87.03±9.69	99.84±9.72^c	13.54±5.17^cd	314.71	<0.05
SP-D(μg/L)	86.13±8.78	93.88±9.71^c	23.75±5.82^cd	227.15	<0.05
WOB(J/L)	1.76±0.31	1.19±0.27^c	0.64±0.23^cd	100.98	<0.05
Raw[cmH₂O/ (L·S)]	85.43±5.57	57.45±4.55^c	49.42±2.58^cd	309.64	<0.05
Cdyn(ml/cmH₂O)	3.73±0.75	4.48±0.51^c	5.39±0.79^cd	34.03	<0.05
PIP(cmH₂O)	28.73±1.45	24.28±1.51^c	21.19±1.49^cd	48.89	<0.05

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Change of serum Clara cell secretory protein 16, tumor necrosis factor-α, interleukin-6 and pulmonary surfactant protein D in children with severe pneumonia

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Change of serum Clara cell secretory protein 16, tumor necrosis factor-α, interleukin-6 and pulmonary surfactant protein D in children with severe pneumonia