Relationships between Th1/Th2 cytokine profiles and chest radiographic manifestations in childhood Mycoplasma pneumoniae pneumonia

Abstract

Background: Mycoplasma pneumoniae pneumonia (MPP) is one of the most common childhood community-acquired pneumonias, and the chest radiograph usually shows bronchial pneumonia, segmental/lobar pneumonia, or segmental/lobar pneumonia with pleural effusion. The imbalance of Th1/Th2 function after Mycoplasma pneumoniae infection is an important immunological mechanism of MPP. In this study, we aimed to evaluate the correlations between Th1/Th2 cytokine profiles and chest radiographic manifestations in MPP children.

Patients and methods: A total of 87 children with MPP were retrospectively reviewed in this study. According to the chest radiographic manifestations, they were divided into the following three groups: bronchial MPP group, segmental/lobar MPP group, and segmental/lobar MPP with pleural effusion group. Clinical features and changes in Th1/Th2 cytokines were further analyzed.

Results: The incidence of tachypnea and cyanosis was higher in children with segmental/lobar MPP with pleural effusion than in those with segmental/lobar or bronchial MPP. The peak body temperature of segmental/lobar MPP was higher than that of bronchial MPP, and the duration of fever and hospitalization was positively correlated with the severity of MPP. MPP children's chest radiograph showed a relationship with the changes in Th1/Th2 cytokines. Serum interleukin-4, interleukin-10 (IL-10), interferon-γ, and tumor necrosis factor-α (TNF-α) of segmental/lobar MPP were significantly higher than those of bronchial MPP, and serum IL-10 (cutoff value: 27.25 pg/mL) can be used as a diagnostic predictor for segmental/lobar MPP. Serum TNF-α and interleukin-6 of segmental/lobar MPP with pleural effusion were significantly higher than those of segmental/lobar MPP without pleural effusion. Serum TNF-α (cutoff value: 60.25 pg/mL) can be used as a diagnostic predictor for segmental/lobar MPP with pleural effusion.

Conclusion: There were significant correlations between Th1/Th2 cytokine profiles and chest radiographic manifestations in MPP children. Serum IL-10 and TNF-α can be used as an optimal predictor for segmental/lobar MPP and segmental/lobar MPP with pleural effusion, respectively.

Keywords: Mycoplasma pneumoniae pneumonia; Th1/Th2; chest radiograph; cytokine.

Figure 1

Comparison of the clinical characteristics with statistically significant differences between the groups. Notes: (A) Tachypnea. (B) Cyanosis. (C) Hypoxia. (D) Peak body temperature. (E) Duration of fever. (F) Duration of hospitalization. Data in (A–C) are shown as stacked bars (percentage of patients), and data in (D–F) are shown as box-whisker plots (median, minimum to maximum).

Figure 2

Comparison of the main laboratory findings between the groups. Notes: (A) WBC. (B) CRP. (C) LDH. (D) IL-2. (E) IL-4. (F) IL-6. (G) IL-10. (H) IFN-γ. (I) TNF-α. Data are shown as column bar graphs (mean with SD). Abbreviations: WBC, white blood cell; CRP, C-reactive protein; LDH, lactate dehydrogenase; IL-2, interleukin-2; IL-4, interleukin-4; IL-6, interleukin-6; IL-10, interleukin-10; IFN-γ, interferon-γ; TNF-α, tumor necrosis factor-α; SD, standard deviation.

Figure 3

ROC curves of CRP, LDH, IL-4, IL-10, IFN-γ, and TNF-α. Note: Diagonal segments are produced by ties. Abbreviations: ROC, receiver operating characteristic; CRP, C-reactive protein; LDH, lactate dehydrogenase; IL-4, interleukin-4; IL-10, interleukin-10; IFN-γ, interferon-γ; TNF-α, tumor necrosis factor-α.

Figure 4

ROC curves of WBC, CRP, LDH, IL-6, and TNF-α. Note: Diagonal segments are produced by ties. Abbreviations: ROC, receiver operating characteristic; WBC, white blood cell; CRP, C-reactive protein; LDH, lactate dehydrogenase; IL-6, interleukin-6; TNF-α, tumor necrosis factor-α.