目的 探討血清和肽素（copeptin）、Toll樣受體2（TLR2）、Toll樣受體4（TLR4）水平與小兒肺炎支原體感染所致重癥肺炎病情、預(yù)后的關(guān)系。方法 選取2016年2月—2019年4月佛山市婦幼保健院收治的361例肺炎支原體感染所致重癥肺炎患兒的臨床資料進(jìn)行回顧分析，另回顧同時(shí)間段體檢中心接收的肺炎支原體感染所致的輕癥肺炎患兒（105例）、健康嬰幼兒童（82例）的資料，分別記為重癥組、輕癥組和健康組；并將重癥組患兒根據(jù)小兒危重病例評(píng)分（PCIS）分為A組（小于70分）、B組（71~80分）、C組（大于80分）。對(duì)比各組患兒的血清和肽素、TLR2和TLR4水平；重癥組患兒PCIS評(píng)分與血清和肽素、TLR2和TLR4水平的關(guān)系；重癥組不同預(yù)后患兒血清和肽素、TLR2和TLR4水平；血清和肽素、TLR2和TLR4水平對(duì)重癥組預(yù)后的預(yù)測(cè)效能。結(jié)果 A組、B組和C組、輕癥組血清和肽素、TLR2和TLR4水平均高于健康組（P<0.05）；A組、B組和C組血清和肽素、TLR2和TLR4水平均高于輕癥組（P<0.05）；且A、B、C 3組間的血清和肽素、TLR2和TLR4水平對(duì)比差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。重癥組所選患兒PCIS評(píng)分與血清和肽素、TLR2和TLR4水平均呈負(fù)相關(guān)，相關(guān)系數(shù)分別為-0.831、-0.885、-0.907（P<0.05）。重癥組死亡率為6.09%（22/361），存活患兒血清和肽素、TLR2和TLR4水平均低于死亡患兒（P<0.05）。血清和肽素、TLR2和TLR4水平預(yù)測(cè)小兒重癥肺炎的最佳截?cái)帱c(diǎn)分別為1.85、11.55、7.18 ng/mL，三者聯(lián)合的靈敏度、特異度、AUC分別為90.91%、97.87%、0.869。結(jié)論 小兒肺炎支原體感染所致的重癥肺炎患兒血清和肽素、TLR2和TLR4水平普遍偏高，建議在肺炎支原體感染所致的重癥肺炎患兒治療中定期檢測(cè)血清和肽素、TLR2和TLR4水平的動(dòng)態(tài)變化，評(píng)估病情和生理狀態(tài)，指導(dǎo)治療，預(yù)測(cè)近期預(yù)后。

Objective To explore the relationship between the levels of serum copeptin, TLR2, TLR4 and the condition and prognosis of severe pneumonia caused by Mycoplasma pneumoniae infection in children. Methods The clinical data of 361 children with severe pneumonia admitted to Foshan Women Children Hospital from February 2016 to April 2019 were reviewed. In addition, the data of children with mild pneumonia (105 cases) and healthy children (82 cases) were received by the physical examination center in the same period were reviewed. The above patients were classified as severe group, mild group, and healthy group. And the children in the severe group were divided into group A (≤ 70 points), group B (71-80 points) and group C (> 80 points) according to the PCIS. Serum levels of copeptin, TLR2, and TLR4 were compared in each group. The relationship between PCIS score and serum levels of copeptin, TLR2 and TLR4; serum levels of copeptin, TLR2, and TLR4 in children with different prognosis in the severe group; and efficacy of serum copeptin, TLR2 and TLR4 levels in predicting prognosis of severe patients were compared. Results The serum levels of copeptin, TLR2 and TLR4 in group A, B, C and the mild disease group were all higher than those in the healthy group (P<0.05). Serum levels of copeptin, TLR2 and TLR4 in group A, B and C were all higher than those in the mild group (P<0.05). The serum levels of Copeptin, TLR2 and TLR4 were significantly different among groups A, B and C (P<0.05). The PCIS scores of children in the severe disease group were negatively correlated with serum copeptin, TLR2 and TLR4 levels, and the correlation coefficients (r) were -0.831, -0.885, and -0.907, respectively (P<0.05). The mortality rate in the severe group was 6.09% (22/361), and the serum levels of copeptin, TLR2 and TLR4 in the surviving children were all lower than those in the dead children (P<0.05). The best cut-off points of serum copeptin, TLR2, and TLR4 levels for predicting severe pneumonia in children were 1.85 ng/mL, 11.55 ng/mL, and 7.18 ng/mL, respectively. The sensitivity, specificity and AUC of the combination were 90.91%, 97.87%, and 0.869, respectively. Conclusion The serum levels of copeptin, TLR2 and TLR4 in children with severe pneumonia caused by mycoplasma pneumoniae infection are generally high. It is suggested that the dynamic changes of serum levels of copeptin, TLR2 and TLR4 should be regularly detected in the treatment of children with severe pneumonia caused by mycoplasma pneumoniae infection, so as to assess the condition and physiological status, guide the treatment and predict the recent prognosis.

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