本文選題：肺炎支原體　切入點(diǎn)：EB病毒　出處：《大連醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：目前肺炎支原體(Mycoplasma pneumoniae MP)合并EB (Epstein-Barr)病毒感染在臨床中非常普遍，其臨床表現(xiàn)較單純支原體感染引起的肺部及肺外損傷重，免疫學(xué)發(fā)病機(jī)制在支原體肺炎（Mycoplasma pneumonia MPP）的發(fā)生、發(fā)展中所起到的作用越來越受到重視。本文旨在研究支原體肺炎、EB病毒感染、肺炎支原體合并EB病毒感染的臨床特點(diǎn)，并進(jìn)一步探討支原體肺炎的免疫狀態(tài)及支原體感染與EB病毒感染的相互關(guān)系，進(jìn)而選擇合理的肺炎支原體合并EB病毒感染的治療方案。 方法：隨機(jī)選擇大連醫(yī)科大學(xué)附屬二院兒科病房2011年1月-2012年1月收治的單純EB病毒感染患兒37例，并隨機(jī)選擇同期收治的支氣管肺炎患兒中單純支原體感染患兒36例及肺炎支原體合并EB病毒感染患兒32例。對(duì)3組患兒血常規(guī)、肝功能、心肌酶譜、肺部影像學(xué)改變及尿常規(guī)等實(shí)驗(yàn)室檢查結(jié)果進(jìn)行回顧性統(tǒng)計(jì)、分析。另隨機(jī)選擇21例支原體肺炎（單純支原體感染）患兒，采用流式細(xì)胞學(xué)方法檢測(cè)T細(xì)胞亞群CD~(4+)、CD~(8+)及CD~(4+)/CD~(8+)比值與健康兒童比較，并通過ELISA法檢測(cè)以上支原體肺炎患兒血清白細(xì)胞介素-6（interleukin-6，IL-6）水平并與健康兒童比較。健康對(duì)照組為同期我院兒科門診正常體檢的兒童，，近2個(gè)月內(nèi)無(wú)感染性疾病史，無(wú)器質(zhì)性疾病。所有兒童采血前均未使用干擾素、免疫球蛋白或輸血等。 結(jié)果：1.2011年1月-2012年1月我院兒科病房共收治支氣管肺炎989例，符合支原體肺炎診斷標(biāo)準(zhǔn)者265例，支原體發(fā)病率為26.79%。 2.支原體肺炎及MP合并EB病毒感染患兒發(fā)病率均以學(xué)齡期偏高。 3.MP合并EB病毒感染患兒ALT異常率、導(dǎo)致肺部大葉實(shí)變幾率及尿常規(guī)異常率均高于單純MP及單純EB病毒感染患兒，混合感染后粒細(xì)胞減低比率偏高于單純EB病毒感染患兒，而與單純支原體感染組比較無(wú)顯著差異�；旌细腥竞驝K-MB異常率偏高于單純MP感染患兒。而與單純EB病毒感染患兒比較并未顯著升高。 4.支原體肺炎患兒與健康對(duì)照組兒童比較CD4比例明顯降低，CD8比例明顯升高，CD4/CD8比值明顯倒置，具有顯著統(tǒng)計(jì)學(xué)意義（P0.01）。 5.支原體肺炎患兒血清IL-6濃度較健康對(duì)照組兒童明顯升高，差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。 結(jié)論： 1.肺炎支原體合并EB病毒感染患兒較單純支原體或單純EB病毒感染患兒肺部感染重，肺外并發(fā)癥多。 2.支原體肺炎患兒CD4、CD8比例倒置，提示存在細(xì)胞免疫紊亂。 3.支原體肺炎患兒血清IL-6偏高于健康兒童，支原體感染可通過誘導(dǎo)機(jī)體分泌IL-6而造成對(duì)組織的損傷，故IL-6的檢測(cè)對(duì)支原體肺炎的診斷及對(duì)評(píng)估病情具有重要意義。 4.肺炎支原體、EB病毒感染機(jī)體后對(duì)機(jī)體造成的損傷往往是由免疫反應(yīng)導(dǎo)致的，因此抗支原體治療及抗EB病毒治療效果不佳時(shí)免疫調(diào)節(jié)治療往往能取得較好的效果。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.6

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