内皮细胞特异性分子-1、1-磷酸鞘氨醇受体3与肺炎支原体肺炎病情和预后的相关性

doi:10.3969/j.issn.1673-8640.2026.03.006

摘要/Abstract

摘要：

目的探讨内皮细胞特异性分子-1（ESM-1）、1-磷酸鞘氨醇受体3（S1PR3）与肺炎支原体肺炎（MPP）患儿病情严重程度的关系及其在预后评估中的价值。方法选取2021年1月—2024年1月安康市妇幼保健院MPP患儿106例（MPP组）和健康体检儿童106名（正常对照组），根据临床肺部感染评分（CPIS）和临床症状将所有MPP患儿分为重症组（69例）和轻症组（37例），根据治疗1个疗程后的CPIS评分分为预后良好组（64例）和预后不良组（42例）。检测所有研究对象血清ESM-1、S1PR3水平和所有患儿的肺功能指标[达峰时间占呼气时间的百分比（TPTEF/Te%）、达峰容积占潮气量的百分比（VPTEF/VT%）和呼吸频率（RR）]。采用Pearson相关分析或Spearman相关分析评价各项指标之间的相关性。采用Logistic回归分析评估MPP患儿预后不良的影响因素。采用受试者工作特征（ROC）曲线评价各项指标判断MPP患儿预后不良的效能。结果 MPP组血清ESM-1、S1PR3水平高于正常对照组（P<0.001）。重症组ESM-1、S1PR3、RR高于轻症组（P<0.001），TPTEF/Te%、VT、VPTEF/VT%低于轻症组（P<0.05）。MPP患儿血清ESM-1、S1PR3水平与RR、病情严重程度均呈正相关（P<0.001），与TPTEF/Te%、VT、VPTEF/VT%均呈负相关（p<0.001）。预后不良组血清ESM-1、S1PR3水平和支气管充气征所占比例高于预后良好组（P<0.001）。ESM-1、S1PR3是MPP患儿预后不良的独立危险因素[比值比（OR）值分别为2.985、2.832，95%可信区间（CI）分别为1.563~5.700、1.452~5.525，P<0.01]。ESM-1、S1PR3单项检测和联合检测判断MPP患儿预后不良的曲线下面积（AUC）分别为0.856、0.855、0.939。结论 MPP患儿血清ESM-1、S1PR3水平均显著升高，且与病情严重程度有关，二者联合检测对MPP患儿预后有较高的预测价值。

关键词: 内皮细胞特异性分子-1, 1-磷酸鞘氨醇受体3, 肺炎支原体肺炎

Abstract:

Objective To investigate the relationship between endothelial cell-specific molecule-1（ESM-1），sphingosine 1-phosphate receptor 3（S1PR3）and the severity of Mycoplasma pneumonia pneumonia（MPP）in children，as well as their value in prognosis assessment. Methods A total of 106 children with MPP（MPP group）and 106 healthy children（healthy control group）were enrolled from Ankang Maternal and Child Health Hospital from January 2021 to January 2024. All the MPP children were classified into severe group（69 cases）and mild group（37 cases）according to the clinical pulmonary infection score（CPIS）and clinical symptoms. All the children were classified into good prognosis group（64 cases）and poor prognosis group（42 cases）according to the CPIS score after one course of treatment. The levels of serum ESM-1 and S1PR3 and the pulmonary function indicators [time to peak tidal expiratory flow（TPTEF/Te%），volume at peak tidal expiratory flow（VPTEF/VT%）and respiratory rate（RR）] were determined. Pearson or Spearman correlation analysis was used to evaluate the correlation between various indicators. Logistic regression analysis was used to assess the influencing factors of poor prognosis in MPP children. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of various indicators in predicting poor prognosis of MPP children. Results The serum ESM-1 and S1PR3 levels in MPP group were higher than those in control group（p<0.001）. The ESM-1，S1PR3 and RR in severe group were higher than those in mild group（P<0.001），while TPTEF/Te%，VT and VPTEF/VT% were lower in severe group（P<0.05）. The serum ESM-1 and S1PR3 levels of MPP children were positively correlated with RR and disease severity（P<0.001），and they were negatively correlated with TPTEF/Te%，VT and VPTEF/VT%（p<0.001）. The serum ESM-1，S1PR3 levels and the proportion of bronchial inflation signs in poor prognosis group were higher than those in good prognosis group（P<0.001）. ESM-1 and S1PR3 were independent risk factors for poor prognosis in MPP children [odds ratios（OR）were 2.985 and 2.832，95% confidence intervals（CI）were 1.563-5.700 and 1.452-5.525，respectively，P<0.01]. The areas under curves（AUC）of ESM-1，S1PR3 single and combined determinations for predicting poor prognosis of MPP children were 0.856，0.855 and 0.939，respectively. Conclusions The serum ESM-1 and S1PR3 levels in MPP children are increased and are related to the disease severity. The combined determination of ESM-1 and S1PR3 has a predictive value for the prognosis of MPP children.

Key words: Endothelial cell-specific molecule-1, Sphingosine 1-phosphate receptor 3, Mycoplasma pneumonia pneumonia

中图分类号:

R446.1

马小苗, 刘锋, 陈粉亭. 内皮细胞特异性分子-1、1-磷酸鞘氨醇受体3与肺炎支原体肺炎病情和预后的相关性[J]. 检验医学, 2026, 41(3): 245-250.

MA Xiaomiao, LIU Feng, CHEN Fenting. Correlation between endothelial cell-specific molecule-1，sphingosine 1-phosphate receptor 3 and the severity and prognosis of Mycoplasma pneumonia pneumonia[J]. Laboratory Medicine, 2026, 41(3): 245-250.

图/表 8

参考文献 22

[1]	翟斌, 韩梅. 肺炎支原体肺炎患儿血清miR-21、miR-146a表达变化及其与炎症因子的相关性[J]. 检验医学, 2024, 39(8):787-792. DOI
[2]	周丽娟, 吴艳凌, 周林, 等. 检测肺炎支原体新方法的建立及应用[J]. 实用临床医药杂志, 2022, 26(19):100-104.
[3]	SONG Z, JIA G, LUO G, et al. Global research trends of Mycoplasma pneumoniae pneumonia in children:a bibliometric analysis[J]. Front Pediatr, 2023, 11:1306234.
[4]	LI D, GU H, CHEN L, et al. Neutrophil-to-lymphocyte ratio as a predictor of poor outcomes of Mycoplasma pneumoniae pneumonia[J]. Front Immunol, 2023, 14:1302702.
[5]	邱崇荣, 彭金亮, 肖小六, 等. 血清endocan水平在老年社区获得性肺炎病情及预后评估的价值[J]. 江西医药, 2022, 57(8):853-855.
[6]	GUZEL D, KALKAN E A, EREN F, et al. Can serum endocan levels be used as an early prognostic marker for endothelial dysfunction in COVID-19?[J]. Angiology, 2022, 73(5):438-444. DOI URL
[7]	WU J, LIANG Y, FU P, et al. Sphingosine-1-phosphate receptor 3 induces endothelial barrier loss via ADAM10-mediated vascular endothelial-cadherin cleavage[J]. Int J Mol Sci, 2023, 24(22):16083. DOI URL
[8]	吴晓娜, 刘娜. 小儿肺炎临床诊疗[M]. 北京: 人民军医出版社, 2014.
[9]	蒋欢欢, 葛金林, 曾余丰. 肺炎支原体合并链球菌感染肺炎IL-10和IL-17及淋巴细胞亚群与预后的关系[J]. 中华医院感染学杂志, 2025, 35(3):331-335.
[10]	中华人民共和国国家卫生健康委员会. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J]. 新发传染病电子杂志, 2024, 9(1):73-79. DOI
[11]	FAN F, LV J, YANG Q, et al. Clinical characteristics and serum inflammatory markers of community-acquired mycoplasma pneumonia in children[J]. Clin Respir J, 2023, 17(7):607-617. DOI PMID
[12]	LUO X Q, LUO J, WANG C J, et al. Clinical features of severe Mycoplasma pneumoniae pneumonia with pulmonary complications in childhood:a retrospective study[J]. Pediatr Pulmonol, 2023, 58(10):2815-2822. DOI URL
[13]	翁翠琦, 陈玉梅, 蒋蕾, 等. 小儿肺炎支原体肺炎血清CRP、PCT、ESR水平与病情严重程度的关系[J]. 中华医院感染学杂志, 2022, 32(8):1220-1223.
[14]	HUREAU M, PORTIER L, PRIN M, et al. Evaluation of endocan as a treatment for acute inflammatory respiratory failure[J]. Cells, 2023, 12(2):257. DOI URL
[15]	KHALAJI A, AMIRKHANI N, SHARIFKASHANI S, et al. Systematic review of endocan as a potential biomarker of COVID-19[J]. Angiology, 2024, 75(2):107-115. DOI URL
[16]	栾海丽, 秦可佳, 段然. 血清 Endocan、补体C3a与重症肺炎患儿病情和预后转归的关系分析[J]. 中国妇幼健康研究, 2024, 35(6):89-95.
[17]	TAŞAR S, FIDANCI İ, BULUT İ, et al. Role of serum endocan levels in children with bacterial and viral pneumonia:a prospective,case-control study[J]. Pediatr Allergy Immunol Pulmonol, 2022, 35(4):145-152. DOI URL
[18]	TERLIZZI M, COLARUSSO C, SOMMA P, et al. S1P-induced TNF-α and IL-6 release from PBMCs exacerbates lung cancer-associated inflammation[J]. Cells, 2022, 11(16):2524. DOI URL
[19]	PENG J, TANG R, HE J, et al. S1PR3 inhibition protects against LPS-induced ARDS by inhibiting NF-κB and improving mitochondrial oxidative phosphorylation[J]. J Transl Med, 2024, 22(1):535. DOI PMID
[20]	WU J, LIANG Y, FENG A, et al. S1PR3 plays a key role in ventilator-induced lung injury:promoter activation,barrier disruption,and therapeutic evaluation[J]. Free Radic Biol Med, 2022, 192(1):75-76.
[21]	李荣, 丘向燕, 刘玉娜, 等. 重症社区获得性肺炎患者血清1磷酸鞘氨醇受体3水平的变化及临床意义[J]. 医药前沿, 2023, 13(12):7-9.
[22]	PIAO J, SU Z, HE J, et al. SphK1 deficiency ameliorates the development of atherosclerosis by inhibiting the S1P/S1PR3/Rhoa/ROCK pathway[J]. Cell Signal, 2024, 121:111252.

组别	例数	ESM-1/（ng·mL^-1）	S1PR3/（ng·mL^-1）
正常对照组	106	4.15±1.63	3.75±0.89
MPP组	106	14.92±4.45	23.54±7.12
t值		23.398	28.396
P值		<0.001	<0.001

组别	例数	ESM-1/（ng·mL^-1）	S1PR3/（ng·mL^-1）
正常对照组	106	4.15±1.63	3.75±0.89
MPP组	106	14.92±4.45	23.54±7.12
t值		23.398	28.396
P值		<0.001	<0.001

组别	例数	ESM-1/（ng·mL^-1）	S1PR3/（ng·mL^-1）	TPTEF/Te%/%	RR/（次·分^-1）	VT/（mL·kg^-1）	VPTEF/VT%/%
轻症组	37	9.04±3.02	13.19±4.75	27.14±4.36	27.15±2.76	7.65±1.21	28.94±3.76
重症组	69	18.07±5.12	29.09±8.94	18.35±2.69	29.13±2.85	7.24±0.82	22.35±3.91
t值		9.837	10.068	12.826	3.447	2.068	8.381
P值		<0.001	<0.001	<0.001	<0.001	0.041	<0.001

组别	例数	ESM-1/（ng·mL^-1）	S1PR3/（ng·mL^-1）	TPTEF/Te%/%	RR/（次·分^-1）	VT/（mL·kg^-1）	VPTEF/VT%/%
轻症组	37	9.04±3.02	13.19±4.75	27.14±4.36	27.15±2.76	7.65±1.21	28.94±3.76
重症组	69	18.07±5.12	29.09±8.94	18.35±2.69	29.13±2.85	7.24±0.82	22.35±3.91
t值		9.837	10.068	12.826	3.447	2.068	8.381
P值		<0.001	<0.001	<0.001	<0.001	0.041	<0.001

组别	例数	性别		年龄/岁	胸腔积液/[例（%）]	肺实变影/[例（%）]	支气管充气征/[例（%）]	发热时间/d
组别	例数	男/[例（%）]	女/[例（%）]	年龄/岁	胸腔积液/[例（%）]	肺实变影/[例（%）]	支气管充气征/[例（%）]	发热时间/d
预后良好组	64	30（46.88）	34（53.12）	5.50±2.02	13（20.31）	57（89.06）	28（43.75）	5.45±1.25
预后不良组	42	21（50.00）	21（50.00）	5.62±2.10	14（33.33）	40（95.24）	35（83.33）	5.60±1.38
统计值		0.099		0.294	2.265	0.577	16.480	0.580
P值		0.753		0.769	0.132	0.448	<0.001	0.563
组别	CRP/（mg·L^-1）	IL-6/（ng·L^-1）		TNF-α/（ng·L^-1）	PLT计数/（×10⁹L^-1）	WBC计数/（×10⁹L^-1）	组别	CRP/（mg·L^-1）
预后良好组	21.75±6.10	34.81±8.60		19.38±5.06	248.72±49.36	10.95±2.72	预后良好组	21.75±6.10
预后不良组	22.89±6.42	36.98±8.56		20.75±4.92	257.93±51.60	10.81±2.69	预后不良组	22.89±6.42
统计值	0.922	1.273		1.378	0.923	0.260	统计值	0.922
P值	0.359	0.206		0.171	0.358	0.795	P值	0.359