Clinical characteristics in children with refractory Mycoplasma pneumoniae pneumonia and its correlation with TLR4 inflammasome
Objective To analyze the clinical characteristics in children with refractory Mycoplasma pneumoniae pneumonia(RMPP)and its correlation with Toll like receptor 4(TLR4)inflammasome.Methods A total of 97 children with Mycoplasma pneumoniae pneumonia admitted to Ankang Hospital of Traditional Chinese Medicine from August 2021 to August 2023 were selected as the research subjects.There were 46 boys and 51 girls,aged 2 to 14 years.At admission,the incidence of RMPP was statistically analyzed and the children were divided into a RMPP group and a general Mycoplasma pneumoniae pneumonia(GMPP)group.The relative expression level(mRNA)of TLR4 mononuclear cells in all children on the next day after admission was measured,the clinical data and TLR4 mRNA of the two groups were compared,and the correlation between TLR4 mRNA and RMPP was analyzed.Independent sample t test,x2 test,logistic regression analysis,and restricted cubic spline(RCS)were used.Results According to statistics,out of 97 children with Mycoplasma pneumoniae pneumonia,33 had RMPP,accounting for 34.02％(33/97).The proportions of fever duration＞7 days,pleural effusion,and lobar atelectasis in the RMPP group were higher than those in the GMPP group,and the length of hospital stay was longer than that in the GMPP group(all P＜0.05).The percentage of neutrophils,levels of C-reactive protein(CRP),interleukin-18(IL-18),IL-1β,IL-6,and immunoglobulin A(IgA),Mycoplasma pneumoniae-DNA,and TLR4 mRNA[(0.92±0.08)vs.(0.88±0.04)]in the RMPP group were higher than those in the GMPP group(all P＜0.05).Logistic regression model was constructed,and the results showed that the percentage of neutrophils,CRP,IL-18,IL-1β,IL-6,IgA,Mycoplasma pneumoniae-DNA,and TLR4 mRNA on admission were all related to the occurrence of RMPP(all P＜0.05).By RCS analysis,there was a non-linear dose-response relationship between TLR4 mRNA and RMPP.When TLR4 mRNA＞0.955,the risk of RMPP increased with the increase of indicator expression level.Conclusions The duration of fever and hospitalization in RMPP children are long,often accompanied by worsening pulmonary signs and imaging manifestations,as well as severe inflammatory reactions and immune damage.TLR4 inflammasomes and their related inflammatory factors are also associated with RMPP.The high expression of TLR4 inflammasomes induces a high inflammatory response,which is an independent risk factor for RMPP,and the correlation between the two is a non-linear dose-response relationship.
Refractory Mycoplasma pneumoniae pneumoniaToll like receptor 4Clinical featuresDose response analysis
万方数据
维普
