【摘要】 目的：探讨肿瘤坏死因子相关激活蛋白(CD40L)、CD4~+/CD8~+、白细胞介素-4(IL-4)与儿童细菌性社区获得性肺炎(CAP)经典炎症标志物的关系及预测抗菌治疗效果的效能。方法：选取300例儿童细菌性CAP患儿，均给予化痰、止咳、平喘及抗感染治疗，其中43例治疗无效(观察组)及257例治疗有效(对照组),比较2组治疗前白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)及CD40L、CD4~+/CD8~+、IL-4,采用Pearson分析CD40L、CD4~+/CD8~+、IL-4与经典炎症标志物的关系及CD40L、CD4~+/CD8~+、IL-4之间的关系，采用logistic回归方程分析CD40L、CD4~+/CD8~+、IL-4与治疗无效的关系，采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析CD40L、CD4~+/CD8~+、IL-4预测抗菌治疗效果的效能。结果：观察组WBC、CRP、PCT、CD40L、IL-4水平均高于对照组(P<0.01),CD4~+/CD8~+低于对照组(P<0.01);CD40L与WBC、CRP、PCT均呈正相关(r=0.720、0.433、0.832,P<0.01),CD4~+/CD8~+与WBC、CRP、PCT呈负相关(r=-0.709、-0.449、-0.698,P<0.01),IL-4与WBC、CRP、PCT呈正相关(r=0.889、0.760、0.723,P<0.01);CD40L、CD4~+/CD8~+、IL-4均与治疗无效的相关性具有统计学意义(P<0.01);CD40L与CD4~+/CD8~+呈负相关(r=-0.776,P<0.01),与IL-4呈正相关(r=0.554,P<0.01);CD4~+/CD8~+与IL-4呈负相关(r=-0.538,P<0.01);单一指标中IL-4预测抗菌治疗效果的AUC最大为0.805,各指标联合预测抗菌治疗效果的AUC为0.867,敏感度达79.07%,大于任一单一指标(P<0.01)。结论：CD40L、IL-4、CD4~+/CD8~+与经典炎症标志物存在一定相关性，可在一定程度上反映细菌性CAP患儿病情程度，治疗期间进行动态监测可及早预测疗效，为细菌性CAP患儿后续治疗提供参考依据。更多还原

【Abstract】 Objective:To investigate the relationship between tumor necrosis factor-related activator protein(CD40 L),CD4~+/CD8~+,interleukin-4(IL-4) and classic inflammatory biomarkers of bacterial pediatric community acquired pneumonia(CAP) and the predictive efficacy in antibacterial therapy.Methods:A total of 300 children with bacterial CAP were selected for treatment of phlegm removing, cough relieving, asthma reducing and anti-infection.The non-response cases were set as observation group(n=43) and the improved cases were set as control group(n=257).The white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),CD40 L,CD4~+/CD8~+ and IL-4 were detected before treatment.Pearson correlation analysis was used to analyze the relationship between CD40 L,CD4~+/CD8~+,IL-4 and classic inflammation markers and the relationship between CD40 L,CD4~+/CD8~+,IL-4.The logistic regression equation was used to analyze the relationship between CD40 L,CD4~+/CD8~+,IL-4 and non-response treatment.The receiver operating characteristic(ROC) curve and the area under the ROC cure(AUC) were used to analyze the predictive efficacy of CD40 L,CD4~+/CD8~+ and IL-4 of antibacterial treatment.Results:WBC,CRP,PCT,CD40 L and IL-4 in the observation group were higher than those in the control group(P<0.01) and CD4~+/CD8~+ was lower than that in the control group(P<0.01).CD40 L was positively correlated with WBC,CRP and PCT(r=0.720,0.433,0.832,P<0.01),CD4~+/CD8~+ was negatively correlated with WBC,CRP and PCT(r=-0.709,-0.449,-0.698,P<0.01),IL-4 was positively correlated with WBC,CRP and PCT(r=0.889,0.760,0.723,P<0.01).CD40 L,CD4~+/CD8~+,IL-4 were all significantly correlated with treatment failure(P<0.01).CD40 L was negatively correlated with CD4~+/CD8~+,and positively correlated with IL-4(r=-0.776,0.554,P<0.01).CD4~+/CD8~+ was negatively correlated with IL-4(r=-0.538,P<0.01).Among the single indicators, the maximum AUC of IL-4 predicting the effect of antibacterial treatment was 0.805,the AUC of each indicator combined to predict the effect of antibacterial treatment was 0.867,and the sensitivity was 79.07%,which was greater than any single indicator(P<0.05).Conclusions:There is a certain correlation between CD40 L,IL-4,CD4~+/CD8~+ and classic inflammatory biomarkers, which can reflect the severity of disease in bacterial pediatric CAP to a certain extent.Dynamic monitoring will provide timely predictive value and better reference for the follow-up treatment of bacterial pediatric CAP.更多还原