Abstract: Objective To analyze the expression levels of serum autotaxin, interleukin-6 (IL-6) and interleukin-33 (IL-33) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP), and to explore their effectiveness in evaluating the risk of transformation from general Mycoplasma pneumoniae pneumonia（GMPP) to refractory RMPP. In order to provide reference information for clinical control of GMPP progression in RMPP. Method A total of 83 children with RMPP and 80 children with GMPP admitted to the Emergency Department of Pengzhou Maternal and Child Health Care Hospital from January 1, 2022 to January 1, 2024 were selected as the research objects, and their demographic and clinical data were collected for retrospective analysis. The correlation between autotaxin, IL-6, and IL-33 with pulmonary function indicators and the risk factors affecting the progression of GMPP to RMPP were analyzed by comparing the general data of GMPP and RMPP groups. Result There were no significant differences in gender, age, BMI, and white blood cell count between GMPP group and RMPP group (P>0.05). Compared with the RMPP group, the GMPP group had a lower proportion of patients with duration of fever ≤10 days, no pleural effusion, and involvement of ≤ single lung lobe, and the RMPP group had higher CT value in the consolidation area and higher levels of autotaxin, IL-6, and IL-33. Tidal volume(VT), time to peak tidal expiratory flow as a proportion of expiratory time(tPTEF/TE) and TEF25/PTEF% in the GMPP group were significantly lower than those in the GMPP group (P<0.05).Logistic regression analysis showed that: duration of fever (>10 days), pleural effusion (small, moderate/large), high CT value of consolidation area, involvement range (multiple lung lobes), increased autotaxin, IL-6, IL-33, VT, tPTEF/TE, TEF25/PTEF% levels were independent risk factors for the progression of GMPP to RMPP (P<0.05). Autotaxin, IL-6 and IL-33 were negatively correlated with VT, tPTEF/TE and TEF25/PTEF% (all P<0.05).The sensitivity and specificity of autotaxin, IL-6, and IL-33 combined detection in predicting the progression of GMPP to RMPP were 92.80% and 88.20%, respectively, which were higher than those of the three alone (P<0.05). Conclusion The expression levels of autotaxin, IL-6, and IL-33 in the serum of children with refractory Mycoplasma pneumoniae pneumonia were significantly increased, which were closely related to the lung function of the patients. They are expected to be used as biological indicators for predicting the progression of GMPP to RMPP in children.

Key words: Refractory Mycoplasma pneumoniae pneumonia, Autotaxin, Interleukin-6, Interleukin-33, Lung function