广西医学

目的探讨血清核苷酸结合寡聚域样受体2（NOD2）、受体相互作用蛋白2（RIP2）、核因子κB（NF⁃κB）的mRNA表达水平与肺炎支原体肺炎患者肺损伤程度的关系及对其预后的预测价值。方法选取117例肺炎支原体肺炎患者作为研究对象，根据患者肺损伤程度分为轻中度组（n=82）和重度组（n=35）。比较两组患者的血清NOD2、RIP2、NF⁃κB mRNA表达水平，采用Pearson检验分析血清NOD2、RIP2、NF⁃κB mRNA表达水平与肺炎支原体肺炎患者肺损伤程度的相关性。随访6个月，根据患者预后情况将其分为预后不良组（n=41）与预后良好组（n=76）。对比预后不良组与预后良好组患者的血清NOD2、RIP2、NF⁃κB mRNA表达水平及临床资料，采用多因素Logistic回归模型分析肺炎支原体肺炎患者预后不良的影响因素。采用受试者工作特征（ROC）曲线评估血清NOD2、RIP2、NF⁃κB mRNA表达水平单独及联合预测肺炎支原体肺炎患者预后不良的价值。结果重度组的血清NOD2、RIP2、NF⁃κB mRNA表达水平高于轻中度组，且血清NOD2、RIP2、NF⁃κB mRNA表达水平与肺损伤评分呈正相关（P<0.05）。多因素Logistic回归分析结果显示，肺损伤程度为重度及血清NOD2 mRNA高表达、RIP2 mRNA高表达、NF⁃κB mRNA高表达为肺炎支原体肺炎患者预后不良的危险因素（P<0.05）。ROC曲线分析结果显示，血清NOD2、RIP2、NF⁃κB mRNA表达水平单独及三者联合预测肺炎支原体肺炎患者预后不良的曲线下面积（AUC）分别为0.799、0.844、0.796、0.914（P<0.05），且三者联合预测的AUC高于三者单独预测的AUC（P<0.05）。结论血清NOD2、RIP2、NF⁃κB mRNA表达水平与肺炎支原体肺炎患者肺损伤程度呈正相关，三者均是肺炎支原体肺炎患者预后不良的影响因素，三者均对患者的预后具有一定的预测效能且三者联合预测的效能更佳。

Objective To explore the relation between serum nucleotide⁃binding oligomeric domain⁃like receptor 2 (NOD2)/receptor⁃interacting protein 2 (RIP2)/nuclear factor kappa B (NF⁃κB) mRNA expressions and degree of pulmonary injury in patients with Mycoplasma pneumoniae pneumonia, as well as the predictive value on their prognosis. Methods A total of 117 patients with Mycoplasma pneumoniae pneumonia were selected as the research subjects, and they were assigned to mild to moderate group (n=82) or severe group (n=35) according to their degree of pulmonary injury. The mRNA expressions of serum NOD2, RIP2, and NF⁃κB were compared between the two groups. The correlation between the mRNA expressions of serum NOD2, RIP2, and NF⁃κB and degree of pulmonary injury in patients with Mycoplasma pneumoniae pneumonia was identified by employing Pearson correlation analysis. After 6⁃month follow⁃up, patients were assigned to poor prognosis group (n=41) or favorable prognosis group (n=76) according to the prognostic status. The mRNA expressions of serum NOD2, RIP2, and NF⁃κB and clinical data were compared between the poor prognosis group and the favorable prognosis group. The influencing factors for poor prognosis in patients with Mycoplasma pneumoniae pneumonia were identified by using multivariate Logistic regression model. The mRNA expressions of serum NOD2, RIP2, and NF⁃κB for alone and jointly predicting the values of poor prognosis in patients with Mycoplasma pneumoniae pneumonia were evaluated by employing receiver operating characteristic (ROC) curve. Results The mRNA expressions of serum NOD2, RIP2, and NF⁃κB in the severe group were higher than those in the mild to moderate group (P<0.05). The mRNA expressions of serum NOD2, RIP2, and NF⁃κB positively correlated with score of pulmonary injury (P<0.05). The results of multivariate Logistic regression analysis revealed that severe pulmonary injury, high expression of serum NOD2 mRNA, high expression of serum RIP2 mRNA, high expression of NF⁃κB serum mRNA were the risk factors for poor prognosis in patients with Mycoplasma pneumoniae pneumonia (P<0.05). The results of ROC curve analysis indicated that the areas under the curve (AUC) of the mRNA expressions of serum NOD2, RIP2, and NF⁃κB for alone and jointly predicting poor prognosis in patients with Mycoplasma pneumoniae pneumonia were 0.799, 0.844, 0.796, and 0.914, respectively (P<0.05), and AUC of the three⁃combined prediction was larger than that of the single prediction (P<0.05). Conclusion The mRNA expressions of serum NOD2, RIP2, and NF⁃κB positively correlate with degree of pulmonary injury in patients with Mycoplasma pneumoniae pneumonia. Both three as above are the influencing factors for poor prognosis in patients with Mycoplasma pneumoniae pneumonia. All the three indicators have certain predictive efficiency for the prognosis of patients, and the combined prediction efficiency of the three indicators is superior.