Abstract：Objective To study the value of absolute counts of lymphocyte subsets in the early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. Methods A retrospective analysis was performed for the clinical data of 244 children with Mycoplasma pneumoniae pneumonia (MPP). Among these children, 166 had MPP, and 58 had RMPP. The two groups were compared in terms of clinical features and laboratory markers such as lymphocyte subsets, lactate dehydrogenase, C-reactive protein, procalcitonin and immunoglobulin E (IgE). The receiver operating characteristic (ROC) curve was used to evaluate the specific indices for predicting RMMP. Results There were significant differences between the two groups in the absolute counts of CD3+, CD4+, CD19+, and CD56+ lymphocytes and the serum levels of lactate dehydrogenase, C-reactive protein, and IgE (P < 0.05). The ROC curve analysis showed that the absolute counts of CD3+, CD4+ and CD19+ lymphocytes had an area under the ROC curve (AUC) of 0.866, 0.900 and 0.842 respectively in the differential diagnosis of RMPP and MPP, with a sensitivity of 86%, 90% and 82% respectively and a specificity of 75%, 70% and 80% respectively. Conclusions The absolute counts of CD3+, CD4+ and CD19+ lymphocytes can be used to predict RMPP in children.
LI Na,MU Ya-Ping,CHEN Jing et al. Value of absolute counts of lymphocyte subsets in the early prediction of refractory Mycoplasma pneumoniae pneumonia in children[J]. CJCP, 2019, 21(6): 511-516.
Lu A, Wang C, Zhang X, et al. Lactate dehydrogenase as a biomarker for prediction of refractory Mycoplasma pneumoniae pneumonia in children[J]. Respir Care, 2015, 60(10):1469-1475.
[2]
Biscardi S, Lorrot M, Marc E, et al. Mycoplasma pneumoniae and asthma in children[J]. Clin Infect Dis, 2004, 38(10):1341-1346.
[3]
Dobbs NA, Odeh AN, Sun X, et al. The multifaceted role of T cell-mediated immunity in pathogenesis and resistance to Mycoplasma respiratory disease[J]. Curr Trends Immunol, 2009, 10:1-19.
[4]
Chen K, Kolls JK. T cell-mediated host immune defenses in the lung[J]. Annu Rev Immunol, 2013, 31:605-633.
[5]
Chiu CY, Chen CJ, Wong KS, et al. Impact of bacterial and viral coinfection on Mycoplasmal pneumonia in childhood community-acquired pneumonia[J]. J Microbiol Immunol Infect, 2015, 48(1):51-56.
[6]
Parrott GL, Kinjo T, Fujita J. A compendium for Mycoplasma pneumoniae[J]. Front Microbiol, 2016, 7:513.
Saraya T, Kurai D, Nakagaki K, et al. Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications[J]. Front Microbiol, 2014, 5:410.
[10]
Kawabe T, Jankovic D, Kawabe S, et al. Memory-phenotype CD4+ T cells spontaneously generated under steady-state conditions exert innate TH1-like effector function[J]. Sci Immunol, 2017, 2(12). pii:eaam9304.
[11]
Odeh AN, Simecka JW. Regulatory CD4+CD25+ T cells dampen inflammatory disease in murine Mycoplasma pneumonia and promote IL-17 and IFN-γ responses[J]. PLoS One, 2016, 11(5):e0155648.
[12]
Atkinson TP, Duffy LB, Pendley D, et al. Deficient immune response to Mycoplasma pneumoniae in childhood asthma[J]. Allergy Asthma Proc, 2009, 30(2):158-165.
[13]
Saraya T, Nakata K, Nakagaki K, et al. Identification of a mechanism for lung inflammation caused by mycoplasma pneumoniae using a novel mouse model[J]. Results Immunol, 2011, 1(1):76-87.
[14]
Techasaensiri C, Tagliabue C, Cagle M, et al. Variation in colonization, ADP-ribosylating and vacuolating cytotoxin, and pulmonary disease severity among Mycoplasma pneumoniae strains[J]. Am J Respir Crit Care Med, 2010, 182(6):797-804.
[15]
Wang M, Wang Y, Yan Y, et al. Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children[J]. Int J Infect Dis, 2014, 29:18-23.
Bodhankar S, Woolard MD, Sun X, et al. NK cells interfere with the generation of resistance against mycoplasma respiratory infection following nasal-pulmonary immunization[J]. J Immunol, 2009, 183(4):2622-2631.
[18]
Jones HP, Tabor L, Sun X, et al. Depletion of CD8+ T cells exacerbates CD4+ Th cell-associated inflammatory lesions during murine mycoplasma respiratory disease[J]. J Immunol, 2002, 168(7):3493-3501.
[19]
Gao M, Wang K, Yang M, et al. Transcriptome analysis of bronchoalveolar lavage fluid from children with Mycoplasma pneumoniae pneumonia reveals natural killer and T cell-proliferation responses[J]. Front Immunol, 2018, 9:1403.
[20]
Wood PR, Hill VL, Burks ML, et al. Mycoplasma pneumoniae in children with acute and refractory asthma[J]. Ann Allergy Asthma Immunol, 2013, 110(5):328-334.
[21]
Smith-Norowitz TA, Silverberg J, Kusonruksa M, et al. Asthmatic children have increased specific anti-Mycoplasma pneumoniae IgM but not IgG or IgE-values independent of history of respiratory tract infection[J]. Pediatr Infect Dis J, 2013, 32(6):599-603.
[22]
Jung JA, Kita H, Yawn BP, et al. Increased risk of serious pneumococcal disease in patients with atopic conditions other than asthma[J]. J Allergy Clin Immunol, 2010, 125(1):217-221.
Inamura N, Miyashita N, Hasegawa S, et al. Management of refractory Mycoplasma pneumoniae pneumonia:utility of measuring serum lactate dehydrogenase level[J]. J Infect Chemother, 2014, 20(4):270-273.
[26]
Miyashita N, Kawai Y, Inamura N, et al. Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults[J]. J Infect Chemother, 2015, 21(3):153-160.
