肺炎支原体肺炎合并EB病毒感染患儿血清sST2水平及其与临床指标的相关性

doi:10.3969/j.issn.1004-583X.2026.05.008

摘要/Abstract

摘要：

目的探讨可溶性生长刺激表达基因2蛋白(soluble suppression of tumorigenicity 2, sST2)在肺炎支原体肺炎合并EB病毒(Epstein-Barr virus, EBV)感染患儿中的水平及其与临床指标的相关性,评估其在疾病严重程度判断中的潜在价值。方法回顾性分析2024年4月-2025年2月于南方医科大学第七附属医院儿科住院治疗的肺炎支原体肺炎合并EBV感染患儿(MP+EB组)69例、单纯肺炎支原体感染患儿(MP组)77例及同期健康体检儿童(HC组)70例的临床资料。检测血清sST2及炎症、心肌损伤、肝功能等实验室指标,采用Spearman相关分析评估sST2与上述各指标的相关性。结果 MP+EB组血清sST2水平高于MP组及HC组(P<0.01),MP组亦高于HC组(P<0.05)。MP+EB组发热时间、住院时间、C反应蛋白、乳酸脱氢酶水平均高于MP组(P<0.05),但两组降钙素原(procalcitonin,PCT)水平差异无统计学意义(P>0.05)。在MP+EB组中,sST2与C反应蛋白、羟丁酸脱氢酶、乳酸脱氢酶、超敏C反应蛋白、天冬氨酸转氨酶、肌酸激酶同工酶MB均呈正相关(r_s分别为0.805、0.792、0.806、0.768、0.394、0.523,P均<0.01),但与PCT无相关性(r_s=0.133,P=0.276);在MP组中,sST2与上述指标亦呈正相关,且与PCT呈正相关(r_s=0.646,P<0.01)。结论血清sST2在肺炎支原体肺炎合并EBV感染患儿中升高,且与炎症、心肌损伤及组织损伤指标密切相关,提示sST2可能作为评估该类患儿病情严重程度的潜在生物标志物,其升高机制可能与病毒感染触发的免疫炎症通路有关。

关键词: 肺炎支原体, EB病毒, 可溶性生长刺激表达基因2蛋白, 儿童, 生物标志物

Abstract:

Objective To investigate the level of soluble suppression of tumorigenicity 2 (sST2) in children with Mycoplasma pneumoniae pneumonia (MPP) complicated by Epstein-Barr virus (EBV) infection, and to assess its correlations with clinical indicators, thereby evaluating its potential value in determining disease severity. Methods Clinical data were retrospectively analyzed for 69 children with MPP complicated by EBV infection (MP+EB group), 77 children with Mycoplasma pneumoniae infection alone (MP group), and 70 healthy children who underwent physical examination during the same period (HC group), all hospitalized in the Department of Pediatrics of the Seventh Affiliated Hospital of Southern Medical University from April 2024 to February 2025. Serum sST2 and laboratory indicators of inflammation, myocardial injury, and liver function were measured. Spearman correlation analysis was used to evaluate the correlations between sST2 and these indicators. Results Serum sST2 levels were higher in the MP+EB group than in the MP group and HC group (P<0.01), and were also higher in the MP group than in the HC group (P<0.05). The MP+EB group had longer fever duration, longer hospital stay, and higher C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels than the MP group (P<0.05), but there was no statistically significant difference in procalcitonin (PCT) levels between the two groups (P>0.05). In the MP+EB group, sST2 was positively correlated with CRP, dydroxybutyrate dehydrogenase, LDH, high-sensitivity C-reactive protein (hs-CRP), aspartate aminotransferase (AST), and creatine kinase-MB (CK-MB) (r_s=0.805, 0.792, 0.806, 0.768, 0.394, and 0.523, respectively; all P<0.01), but showed no correlation with PCT (r_s=0.133, P=0.276). In the MP group, sST2 was also positively correlated with the above indicators and was additionally positively correlated with PCT (r_s=0.646, P<0.01). Conclusion Serum sST2 is elevated in children with MPP complicated by EBV infection and is closely associated with inflammation, myocardial injury, and tissue injury markers. These findings suggest that sST2 may serve as a potential biomarker for assessing disease severity in these patients, and that its elevation may be related to immune-inflammatory pathways triggered by viral infection.

Key words: Mycoplasma pneumoniae, Epstein-Barr virus, soluble suppression of tumorigenicity 2, children, biomarker

中图分类号:

R375.2

叶琪, 王莹莹, 邱欣, 陈文科, 操龙斌. 肺炎支原体肺炎合并EB病毒感染患儿血清sST2水平及其与临床指标的相关性[J]. 临床荟萃, 2026, 41(5): 441-446.

Ye Qi, Wang Yingying, Qiu Xin, Chen Wenke, Cao Longbin. Serum sST2 levels in children with Mycoplasma pneumoniae pneumonia complicated by Epstein-Barr virus infection and their correlation with clinical indicators[J]. Clinical Focus, 2026, 41(5): 441-446.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.05.008

https://www.lchc.cn/CN/Y2026/V41/I5/441

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参考文献 20

[1]	Kashyap S, Sarkar M. Mycoplasma pneumonia: Clinical features and management[J]. Lung India, 2010, 27(2):75-85. doi:10.4103/0970-2113.63611.
[2]	Cohen JI. Epstein-Barr virus infection[J]. N Engl J Med, 2000, 343(7):481-492. doi:10.1056/NEJM200008173430707.
[3]	Xu Y, Li S, Liu J, et al. Impact of Epstein-Barr virus coinfection in Mycoplasma pneumoniae pneumonia[J]. Medicine (Baltimore), 2020, 99(16):e19792. doi:10.1097/MD.0000000000019792.
[4]	高颂轶, 赵文静, 谢紫阳, 等. 肺炎支原体混合EB病毒感染的临床免疫特征分析[J]. 中国妇幼健康研究, 2022, 33(5):53-58.
[5]	Liew FY, Girard JP, Turnquist HR. Interleukin-33 in health and disease[J]. Nat Rev Immunol, 2016, 16(11):676-689. doi:10.1038/nri.2016.95. pmid: 27640624
[6]	Zeng Z, Hong XY, Li Y, et al. Serum-soluble ST2 as a novel biomarker reflecting inflammatory status and illness severity in patients with COVID-19[J]. Biomark Med, 2020, 14(17):1619-1629. doi:10.2217/bmm-2020-0410. pmid: 33336592
[7]	Arnaldos-Carrillo M, Noguera-Velasco JA, Martínez-Ardil IM, et al. Value of increased soluble suppressor tumorigenicity biomarker 2 (sST2) on admission as an indicator of severity in patients with COVID-19[J]. Med Clin (Barc), 2023, 161(5):185-191. doi:10.1016/j.medcli.2023.04.005. pmid: 37137804
[8]	曹练, 穆艳顺, 张丽红, 等. 血清人类β防御素2、可溶性生长刺激表达基因2蛋白表达水平对儿童难治性支原体肺炎的诊断价值[J]. 实用临床医药杂志, 2025, 29(6):20-23+29.
[9]	中华医学会儿科学分会呼吸学组, 《中华实用儿科临床杂志》编辑委员会. 儿童肺炎支原体肺炎诊治专家共识(2015年版)[J]. 中华实用儿科临床杂志, 2015, 30(17):1304-1308. doi:10.3760/cma.j.issn.2095-428X.2015.17.006.
[10]	中华医学会儿科学分会感染学组, 全国儿童EB病毒感染协作组. 儿童EB病毒感染相关疾病的诊断和治疗原则专家共识[J]. 中华儿科杂志, 2021, 59(11):905-911. doi:10.3760/cma.j.cn112140-20210618-00513.
[11]	陈建琴, 吴建刚, 王朝晖, 等. EB病毒伴肺炎支原体感染致IM的临床特征及发病的危险因素分析[J]. 中国病原生物学杂志, 2022, 17(3):344-347.doi:10.13350/j.cjpb.220321.
[12]	翟谨, 徐俊, 何萍, 等. 儿童Epstein-Barr病毒合并肺炎支原体感染的临床特点[J]. 临床荟萃, 2020, 35(2):174-176. doi: 10.3969/j.issn.1004-583X.2020.02.016
[13]	李勇超, 宋丹丹, 于智勤, 等. 重症肺炎支原体肺炎合并EB病毒感染的临床及实验室特征[J]. 检验医学与临床, 2024, 21(11):1568-1572.
[14]	芮隽, 孔飞. 小儿EB病毒感染合并肺炎支原体肺炎的Logistic回归分析[J]. 皖南医学院学报, 2026, 45(1):55-58.
[15]	Kaur D, Chachi L, Gomez E, et al. ST2 expression and release by the bronchial epithelium is downregulated in asthma[J]. Allergy, 2020, 75(12):3184-3194. doi:10.1111/all.14436.
[16]	Mehraj V, Jenabian MA, Ponte R, et al. The plasma levels of soluble ST2 as a marker of gut mucosal damage in early HIV infection[J]. AIDS, 2016, 30(10):1617-1627. doi:10.1097/QAD.0000000000001105. pmid: 27045377
[17]	沈伟荣, 胡冰玉. 支原体肺炎合并EB阳性儿童免疫功能指标水平和临床意义[J]. 中国妇幼保健, 2021, 36(18):4273-4275.
[18]	Griesenauer B, Paczesny S. The ST2/IL-33 axis in immune cells during inflammatory diseases[J]. Front Immunol, 2017, 8:475. doi:10.3389/fimmu.2017.00475. pmid: 28484466
[19]	姚艳青, 孔玮晶, 丁瑛雪, 等. 合并肺炎支原体感染的儿童EB病毒传染性单核细胞增多症的临床特点及高危因素分析[J]. 临床和实验医学杂志, 2021, 20(7):762-766.
[20]	Pascual-Figal DA, Januzzi JL. The biology of ST2: The international ST2 consensus panel[J]. Am J Cardiol, 2015, 115(7 Suppl):3B-7B. doi:10.1016/j.amjcard.2015.01.034.

组别	例数	年龄(岁)	男性[例(%)]	发热时间(d)	咳嗽时间(d)	住院时间(d)
MP组	77	6(3,8)	38(49.4)	4(3,6)	4(3,6)	5(3,6)
MP+EB组	69	5(4,7)	35(50.7)	6(5,8)	5(3,7)	6(5,8)
HC组	70	5(4,6)	35(50.0)	-	-	-
Z/H值		0.103	0.404	-2.545	-0.435	-5.347
P值		0.950	0.817	0.011	0.663	<0.01

组别	例数	年龄(岁)	男性[例(%)]	发热时间(d)	咳嗽时间(d)	住院时间(d)
MP组	77	6(3,8)	38(49.4)	4(3,6)	4(3,6)	5(3,6)
MP+EB组	69	5(4,7)	35(50.7)	6(5,8)	5(3,7)	6(5,8)
HC组	70	5(4,6)	35(50.0)	-	-	-
Z/H值		0.103	0.404	-2.545	-0.435	-5.347
P值		0.950	0.817	0.011	0.663	<0.01

项目	MP组(n=77)	MP+EB组(n=69)	Z/t值	P值
CRP(mg/L)	9.81(2.68,23.85)	26.91(19.31,35.02)	3.996	<0.01
WBC(×10⁹/L)	7.13(5.61,8.75)	8.15(5.96,10.44)	2.103	0.035
NEU(×10⁹/L)	3.81(3.08,5.09)	4.54(2.72,5.80)	1.203	0.229
LYM(×10⁹/L)	2.20(1.41,3.19)	2.47(1.82,3.15)	1.411	0.158
PLT(×10⁹/L)	307(248,365)	304(245,372)	0.289	0.773
MON(×10⁹/L)	0.51(0.30,0.66)	0.48(0.33,0.63)	0.077	0.938
HBDH(U/L)	226.00(202.00,285.00)	237.00(200.50,271.50)	0.106	0.917
PA(mg/L)	111.00(87.00,151.00)	108.00(94.00,143.50)	0.046	0.964
GLB(g/L)	28.00(25.20,29.90)	28.70(26.05,31.00)	1.742	0.081
ALB(g/L)	40.40(38.50,42.40)	40.60(39.30,42.20)	0.325	0.745
LDH(U/L)	273.00(240.00,300.00)	328.00(279.00,365.00)	4.706	<0.01
GGT(U/L)	9.00(7.00,11.00)	9.00(8.00,11.00)	0.363	0.716
ALT(U/L)	14.00(11.00,17.00)	12.00(10.00,14.50)	2.441	0.015
AST(U/L)	34.00(28.00,43.00)	32.00(28.00,39.00)	1.267	0.205
CR(μmol/L)	27.00(21.00,34.00)	29.00(25.00,33.50)	1.186	0.235
CK(U/L)	113.40(87.00,166.00)	102.00(80.50,147.50)	1.562	0.118
CK-MB(U/L)	26.90(21.00,35.50)	29.60(20.00,43.40)	0.768	0.442
UREA(mmol/L)	3.23±0.76	3.34±0.78	0.866	0.386
TP(g/L)	66.90(65.60,69.40)	70.20(66.90,71.90)	3.488	<0.01
PCT(μg/L)	0.13(0.07,0.28)	0.11(0.09,0.58)	0.563	0.581
hs-CRP(mg/L)	5.43(1.58,13.37)	7.19(2.84,16.59)	0.954	0.340

项目	MP组(n=77)	MP+EB组(n=69)	Z/t值	P值
CRP(mg/L)	9.81(2.68,23.85)	26.91(19.31,35.02)	3.996	<0.01
WBC(×10⁹/L)	7.13(5.61,8.75)	8.15(5.96,10.44)	2.103	0.035
NEU(×10⁹/L)	3.81(3.08,5.09)	4.54(2.72,5.80)	1.203	0.229
LYM(×10⁹/L)	2.20(1.41,3.19)	2.47(1.82,3.15)	1.411	0.158
PLT(×10⁹/L)	307(248,365)	304(245,372)	0.289	0.773
MON(×10⁹/L)	0.51(0.30,0.66)	0.48(0.33,0.63)	0.077	0.938
HBDH(U/L)	226.00(202.00,285.00)	237.00(200.50,271.50)	0.106	0.917
PA(mg/L)	111.00(87.00,151.00)	108.00(94.00,143.50)	0.046	0.964
GLB(g/L)	28.00(25.20,29.90)	28.70(26.05,31.00)	1.742	0.081
ALB(g/L)	40.40(38.50,42.40)	40.60(39.30,42.20)	0.325	0.745
LDH(U/L)	273.00(240.00,300.00)	328.00(279.00,365.00)	4.706	<0.01
GGT(U/L)	9.00(7.00,11.00)	9.00(8.00,11.00)	0.363	0.716
ALT(U/L)	14.00(11.00,17.00)	12.00(10.00,14.50)	2.441	0.015
AST(U/L)	34.00(28.00,43.00)	32.00(28.00,39.00)	1.267	0.205
CR(μmol/L)	27.00(21.00,34.00)	29.00(25.00,33.50)	1.186	0.235
CK(U/L)	113.40(87.00,166.00)	102.00(80.50,147.50)	1.562	0.118
CK-MB(U/L)	26.90(21.00,35.50)	29.60(20.00,43.40)	0.768	0.442
UREA(mmol/L)	3.23±0.76	3.34±0.78	0.866	0.386
TP(g/L)	66.90(65.60,69.40)	70.20(66.90,71.90)	3.488	<0.01
PCT(μg/L)	0.13(0.07,0.28)	0.11(0.09,0.58)	0.563	0.581
hs-CRP(mg/L)	5.43(1.58,13.37)	7.19(2.84,16.59)	0.954	0.340

指标	sST2
	MP组(n=77)		MP+EB组(n=69)
	r_s值	P值	r_s值	P值
CRP	0.423	<0.01	0.805	<0.01
WBC	0.004	0.971	0.019	0.875
NEU	0.011	0.922	0.159	0.191
LYM	0.046	0.692	0.022	0.855
PLT	-0.167	0.210	0.092	0.451
MON	0.119	0.301	0.065	0.602
HBDH	0.304	0.007	0.792	<0.01
PA	0.035	0.762	0.072	0.559
GLB	-0.285	0.012	0.161	0.186
ALB	-0.023	0.844	0.221	0.069
LDH	0.416	<0.01	0.806	<0.01
GGT	0.165	0.152	0.030	0.809
ALT	0.123	0.286	0.136	0.263
AST	0.351	0.002	0.394	0.001
CR	-0.300	0.008	-0.334	0.005
CK	0.144	0.213	0.148	0.225
CK-MB	0.642	<0.01	0.523	<0.01
UREA	-0.266	0.048	-0.069	0.581
TP	-0.314	0.006	0.027	0.824
PCT	0.646	<0.01	0.133	0.276
hs-CRP	0.310	0.006	0.768	<0.01
住院天数	0.005	0.966	0.090	0.463
发热天数	0.050	0.671	0.188	0.123
咳嗽天数	0.080	0.488	0.012	0.936