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.
GUO Shan-Chun,XU Chuan-Wei,LIU Yu-Qin et al. Changes in plasma levels of thrombomodulin and D-dimer in children with different types of Mycoplasma pneumoniae pneumonia[J]. CJCP, 2013, 15(8): 619-622.
Waites KB. What's new in diagnostic testing and treatment approaches for Mycoplasma pneumoniae infections in children?[J]. Adv Exp Med Biol, 2011, 719: 47-57.
[4]
Lin SM, Wang YM, Lin HC, Lee KY, Hang CD, Liu CY, et al. Serum thrombomodulin level relates to the clinical course of disseminated intravascular coagulation, multiorgan dysfunction syndrome, and mortality in patients with seosis[J]. Crit Care Med, 2008, 36(3): 683-689.
