肺炎支原体肺炎患儿白细胞介素-41水平与疾病严重程度的多中心回顾性队列研究

doi:10.3877/cma.j.issn.1674-1358.2026.03.003

中华实验和临床感染病杂志(电子版) ›› 2026, Vol. 20 ›› Issue (03) : 148 -154. doi: 10.3877/cma.j.issn.1674-1358.2026.03.003

论著

肺炎支原体肺炎患儿白细胞介素-41水平与疾病严重程度的多中心回顾性队列研究

王鹤¹, 林铃¹, 张春盼¹, 谷培云¹, 蔡宇昂¹, 胡岚¹, 史大伟², 辛德莉¹, 齐文杰¹^,^†(

)

¹　100050　北京，首都医科大学附属北京友谊医院感染内科
²　100050　北京，首都医科大学附属北京友谊医院儿科

收稿日期:2025-07-01 出版日期:2026-06-15
通信作者: 齐文杰
基金资助:
国家临床重点专科建设项目(国卫办医政函〔2022〕468号，国卫医政质量便函〔2023〕2号); 高层次公共卫生技术人才建设项目(学科带头人-02-29)

Multicenter retrospective cohort study on interleukin-41 level and disease severity among children with Mycoplasma pneumoniae pneumonia

He Wang¹, Ling Lin¹, Chunpan Zhang¹, Peiyun Gu¹, Yu’ang Cai¹, Lan Hu¹, Dawei Shi², Deli Xin¹, Wenjie Qi¹^,^†()

¹ Department of Infectious Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
² Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

Received:2025-07-01 Published:2026-06-15
Corresponding author: Wenjie Qi

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引用本文：

王鹤, 林铃, 张春盼, 谷培云, 蔡宇昂, 胡岚, 史大伟, 辛德莉, 齐文杰. 肺炎支原体肺炎患儿白细胞介素-41水平与疾病严重程度的多中心回顾性队列研究[J/OL]. 中华实验和临床感染病杂志(电子版), 2026, 20(03): 148-154.

He Wang, Ling Lin, Chunpan Zhang, Peiyun Gu, Yu’ang Cai, Lan Hu, Dawei Shi, Deli Xin, Wenjie Qi. Multicenter retrospective cohort study on interleukin-41 level and disease severity among children with Mycoplasma pneumoniae pneumonia[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2026, 20(03): 148-154.

目的

探讨新型免疫调节因子白细胞介素（IL）-41在肺炎支原体肺炎（MPP）患儿中的表达特征，分析其与疾病严重程度的相关性、诊断效能及对重症的预警价值。

方法

采用回顾性队列研究，纳入2024年全年首都医科大学附属北京友谊医院和河北以岭医院收治的32例18岁以下MPP患儿，包括轻症17例（轻症组）和重症15例（重症组），另选取8例体检儿童为健康对照组。采用酶联免疫吸附测定试验（ELISA）检测入组儿童血清IL-41水平，并比较各组儿童性别、年龄以及C-反应蛋白（CRP）、降钙素原（PCT）和IL-6等实验室指标水平。采用受试者操作特征（ROC）曲线评估各指标对重症MPP的诊断效能，应用相关性热图分析血清IL-41水平与临床指标的相关性。

结果

入组的32例MPP患儿中男性11例（34.4%）、女性21例（65.6%），平均年龄（8.60±2.89）岁。轻症组与重症组MPP患儿年龄[（9.06±3.45）岁 vs.（8.07±2.09）岁]差异无统计学意义（t=0.393、P=0.697）。轻症组MPP患儿较健康对照组儿童IL-41水平显著升高[（182.191±65.364）pg/ml vs.（137.628±2.914）pg/ml]，差异有统计学意义（t=2.805、P=0.013）；而重症组与健康对照组，轻症组与重症组MPP患儿IL-41水平差异均无统计学意义（P均＞0.05）。IL-41、CRP和IL-6单一指标区分轻、重症MPP的ROC曲线下面积（AUC）分别为0.652、0.590和0.522，效能均不理想；但三者联合区分的AUC可显著提升至0.768（95%CI：0.598～0.938、P=0.013），敏感度和特异度分别为93.8%和57.1%。轻症组患儿IL-41/CRP[24.47（7.4，41.1）]、IL-41/IL-6[26.88（9.1，34.6）]比值较重症组[10.81（1.3，18.9）和9.85（1.7，15.1）]均显著升高，差异有统计学意义（Z=－3.946、－1.957，P均＜0.001）。Spearman相关性分析则显示，MPP患儿血清IL-41与IL-6水平呈显著正相关（r=0.64、P=0.020）。

结论

MPP轻症患儿血清IL-41水平显著上调，而重症MPP患儿虽升高但不显著，提示IL-41可能作为抗炎因子发挥重症保护作用。IL-41、CRP和IL-6水平联合检测可提高对重症MPP的诊断效能，动态监测IL-41水平或有助于MPP患儿的病情评估。

关键词: 儿童, 肺炎支原体肺炎, 白细胞介素-41, 疾病严重程度, 免疫调节, 诊断效能

Objective

To investigate the expression profile of novel immunomodulatory factor interleukin (IL)-41 in pediatric patients with Mycoplasma pneumoniae pneumonia (MPP), and to analyze its correlation with disease severity, diagnostic efficacy and value for predicting severe progression.

Methods

Total of 32 children with MPP under 18 years old, admitted to Beijing Friendship Hospital, Capital Medical University and Hebei Yiling Hospital throughout 2024 were enrolled for retrospective cohort study, including 17 cases of mild disease (mild group) and 15 cases of severe disease (severe group), while 8 healthy children undergoing physical examinations were selected as the control group. Serum IL-41 level was detected in enrolled children by enzyme-linked immunosorbent assay (ELISA), and parameters such as gender, age, C-reactive protein (CRP), procalcitoninand (PCT) and IL-6 levels were compared, respectively. The diagnostic efficacy of these markers for severe MPP was evaluated by receiver operating characteristic (ROC) curve, the relationships between serum IL-41 level and clinical indicators were analyzed by correlation heatmaps.

Results

Among the 32 enrolled ediatric patients with MPP, there were 11 males (34.4%) and 21 females (65.6%), with a mean age of (8.60±2.89) years old. There was no statistically significant difference in age between mild group and severe group [(9.06±3.45) years old vs. (8.07±2.09) years old] (t=0.393, P=0.697). IL-41 level of MPP children in mild group was significantly higher than that of healthy control group [(182.191±65.364) pg/ml vs. (137.628±2.914) pg/ml], with significant difference (t=2.805, P=0.013). But there were no significant difference of IL-41 level between severe group and healthy control group, or between mild group and severe group (all P>0.05). The area under the ROC curve (AUC) for diagnostic differentiation between mild group and severe group by individual biomarkers IL-41, CRP and IL-6 were 0.652, 0.590 and 0.522, respectively, all showing suboptimal performance. However, the three idicators combined AUC significantly improved to 0.768 (95%CI: 0.598-0.938, P=0.013), with the sensitivity and specificity of 93.8% and 57.1%, respectively. In mild group, the IL-41/CRP ratio [24.47 (7.4, 41.1)] and IL-41/IL-6 ratio [26.88 (9.1, 34.6)] were significantly higher than those of severe group [10.81 (1.3, 18.9) and 9.85 (1.7, 15.1)], with significant differences (Z=－3.946 and －1.957, both P<0.001). Spearman correlation analysis demonstrated a significant positive correlation between serum IL-41 and IL-6 levels of patients with MPP (r=0.64, P=0.020).

Conclusions

Serum IL-41 level is significantly elevated in children with mild MPP, which was elevated but without significance in severe MPP cases, suggesting that IL-41 may exert a protective effect against severe disease as an anti-inflammatory factor. Combined detection of IL-41, CRP and IL-6 enhances the diagnostic accuracy for severe MPP, and dynamic monitoring of IL-41 level may aid in disease progression assessment of patients with MPP.

Key words: Children, Mycoplasma pneumoniae pneumonia, Interleukin-41, Disease severity, Immunoregulation, Diagnostic efficacy

表1 对照组、轻症组与重症组MPP患儿基本资料

基本资料	轻症组（17例）	重症组（15例）	健康对照组（8例）	统计量	P值
性别（男/女）	6/11	5/10	3/5	χ²=0.105	0.949^a
年龄（ $x ¯$ ±s，岁）	9.06±3.45	8.07±2.09	8.25±2.56	F=0.521	0.598
WBC（ $x ¯$ ±s，× 10⁹/L）	6.70±1.54	6.45±2.04	—	t=0.375	0.710
CRP [M（P₂₅，P₇₅），mg/L]	14.72（8.88，18.24）	15.89（9.46，39.64）	—	Z=－0.789	0.430
ALT（ $x ¯$ ±s，U/L）	16.47±7.88	13.73±8.06	—	t=0.969	0.341
Crea（ $x ¯$ ±s，mmol/L）	44.16±9.03	41.13±9.78	—	t=0.905	0.373
PCT [M（P₂₅，P₇₅），ng/ml]	0.18（0.12，0.23）	0.13（0.08，0.17）	—	Z=1.466	0.143
IL-6 [M（P₂₅，P₇₅），ng/ml]	13.50（9.30，16.80）	11.90（8.80，33.60）	—	Z=－0.378	0.706
IL-41（ $x ¯$ ±s，pg/ml）	182.19±65.36	154.25±31.11	137.63±2.91	F=3.352	0.046

表1 对照组、轻症组与重症组MPP患儿基本资料

基本资料	轻症组（17例）	重症组（15例）	健康对照组（8例）	统计量	P值
性别（男/女）	6/11	5/10	3/5	χ²=0.105	0.949^a
年龄（ $x ¯$ ±s，岁）	9.06±3.45	8.07±2.09	8.25±2.56	F=0.521	0.598
WBC（ $x ¯$ ±s，× 10⁹/L）	6.70±1.54	6.45±2.04	—	t=0.375	0.710
CRP [M（P₂₅，P₇₅），mg/L]	14.72（8.88，18.24）	15.89（9.46，39.64）	—	Z=－0.789	0.430
ALT（ $x ¯$ ±s，U/L）	16.47±7.88	13.73±8.06	—	t=0.969	0.341
Crea（ $x ¯$ ±s，mmol/L）	44.16±9.03	41.13±9.78	—	t=0.905	0.373
PCT [M（P₂₅，P₇₅），ng/ml]	0.18（0.12，0.23）	0.13（0.08，0.17）	—	Z=1.466	0.143
IL-6 [M（P₂₅，P₇₅），ng/ml]	13.50（9.30，16.80）	11.90（8.80，33.60）	—	Z=－0.378	0.706
IL-41（ $x ¯$ ±s，pg/ml）	182.19±65.36	154.25±31.11	137.63±2.91	F=3.352	0.046

图1 血清IL-41、CRP、IL-6单独及联合检测诊断重症MPP的ROC曲线

表2 IL-41、CRP和IL-6对重症MPP的诊断效能

指标	敏感度（%）	特异度（%）	约登指数	AUC	95%CI	P值
IL-41	58.8	83.3	0.422	0.652	0.449～0.855	0.170
CRP	99.9	48.3	0.483	0.590	0.386～0.794	0.380
IL-6	40.0	99.7	0.400	0.522	0.299～0.744	0.835
联合检测	93.8	57.1	0.538	0.768	0.598～0.938	0.013

表2 IL-41、CRP和IL-6对重症MPP的诊断效能

指标	敏感度（%）	特异度（%）	约登指数	AUC	95%CI	P值
IL-41	58.8	83.3	0.422	0.652	0.449～0.855	0.170
CRP	99.9	48.3	0.483	0.590	0.386～0.794	0.380
IL-6	40.0	99.7	0.400	0.522	0.299～0.744	0.835
联合检测	93.8	57.1	0.538	0.768	0.598～0.938	0.013

表3 轻症组和重症组MPP患儿IL-41/CRP和PCT/IL-6比值 [M（P₂₅，P₇₅）]

组别	例数	IL-41/CRP	IL-41/PCT	IL-41/IL-6
轻症组	17	24.47（7.4，41.1）	1.22（0.6，1.6）	26.88（9.1，34.6）
重症组	15	10.81（1.3，18.9）	1.69（0.7，2.1）	9.85（1.7，15.1）
Z值		－3.946	－1.164	－1.957
P值		＜0.001	0.107	＜0.001

表3 轻症组和重症组MPP患儿IL-41/CRP和PCT/IL-6比值 [M（P₂₅，P₇₅）]

组别	例数	IL-41/CRP	IL-41/PCT	IL-41/IL-6
轻症组	17	24.47（7.4，41.1）	1.22（0.6，1.6）	26.88（9.1，34.6）
重症组	15	10.81（1.3，18.9）	1.69（0.7，2.1）	9.85（1.7，15.1）
Z值		－3.946	－1.164	－1.957
P值		＜0.001	0.107	＜0.001

图2 MPP患儿IL-41与其他指标的相关性热图注：采用Spearman相关性分析，图中颜色深浅表示相关性系数（r值）的大小，冷色调（绿色）代表正相关，暖色调（红色）代表负相关；颜色越深，表示相关性越强

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Multicenter retrospective cohort study on interleukin-41 level and disease severity among children with Mycoplasma pneumoniae pneumonia

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Multicenter retrospective cohort study on interleukin-41 level and disease severity among children with Mycoplasma pneumoniae pneumonia