儿童肺炎支原体肺炎外周血Th17/Treg平衡对肺功能和预后的影响OA

Objective To investigate the effect of peripheral blood T helper 17(Th17)/regulatory T cell(Treg)balance on pulmonary function and prognosis in children with Mycoplasma pneumoniae pneumonia(MPP).Methods A retrospective analysis was conducted on 190 children with MPP admitted to Taizhou Fourth People's Hospital between March 2022 and March 2024(MPP group).Ninety-five age-matched healthy children undergoing physical examination during the same period were enrolled as the control group.Levels of peripheral blood Th17 and Treg cells and pulmonary function parameters were measured in all subjects.Pearson correlation analysis was performed to assess the relationship be-tween Th17/Treg balance and pulmonary function.According to outcomes at 28 days after treatment,MPP patients were divided into a good prognosis group and a poor prognosis group.Multivariate logistic regression was used to identify inde-pendent risk factors for poor prognosis,and receiver operating characteristic(ROC)curve analysis was applied to evaluate the predictive value of Th17/Treg-related indicators.Results Compared with the control group,children in the MPP group showed significantly higher proportions of Th17 cells and Th17/Treg ratios,and lower proportions of Treg cells(P＜0.05).Pulmonary function indices,including forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC),and FEV1/FVC,were significantly reduced in the MPP group(P＜0.05).Pearson analysis demonstrated that the proportion of Treg cells was positively correlated with FEV1,FVC,and FEV1/FVC(P＜0.05),whereas Th17 cell proportion and Th17/Treg ratio were negatively correlated with these pulmonary function parameters(P＜0.05).Among the 190 children with MPP,51 had a poor prognosis and 139 had a good prognosis,yielding a poor prognosis rate of 26.84％.Compared with the good prognosis group,the poor prognosis group had higher Th17 cell proportions and Th17/Treg ratios,and lower Treg cell proportions(P＜0.05).Peak body temperature,duration of fever,and the proportion of patients with ≥2 systemic organ injuries were also significantly higher in the poor prognosis group(P＜0.05).Multivari-ate logistic regression analysis identified prolonged fever duration,≥2 systemic organ injuries,higher Th17 cell propor-tion,and higher Th17/Treg ratio as independent risk factors for poor prognosis(P＜0.05,OR＞1),while a higher Treg cell proportion was a protective factor(P＜0.05,OR＜1).ROC analysis showed that the area under the curve(AUC,95％CI)for predicting poor prognosis was 0.712(0.642-0.775)for Th17 cell proportion,0.744(0.676-0.804)for Treg cell proportion,0.720(0.651-0.804)for Th17/Treg ratio,and 0.900(0.848-0.938)for their combined as-sessment.The combined predictive performance was significantly superior to that of any single indicator(P＜0.05).Conclusion Imbalance of the Th17/Treg immune axis is closely associated with impaired pulmonary function in children with MPP.A high Th17 proportion,low Treg proportion,and elevated Th17/Treg ratio are significant risk factors for poor prognosis.Combined assessment of these indicators can significantly improve prognostic prediction in pediatric MPP.