Correlation of NETs，FOXM1，and IL-17 A with the Progression of MPP to Necrotizing Pneumonia in Children

Rui BI; Zixuan SONG; Jialing JIANG; Congcong ZHANG

doi:10.12259/j.issn.2095-610X.S20260000

Article Contents

Article Navigation > Journal of Kunming Medical University > 2026 > Accepted Manuscript

Rui BI, Zixuan SONG, Jialing JIANG, Congcong ZHANG. Correlation of NETs，FOXM1，and IL-17 A with the Progression of MPP to Necrotizing Pneumonia in Children[J]. Journal of Kunming Medical University. doi: 10.12259/j.issn.2095-610X.S20260000

Citation:

Rui BI, Zixuan SONG, Jialing JIANG, Congcong ZHANG. Correlation of NETs，FOXM1，and IL-17 A with the Progression of MPP to Necrotizing Pneumonia in Children[J]. Journal of Kunming Medical University. doi: 10.12259/j.issn.2095-610X.S20260000

Citation:

PDF( 868 KB)

Correlation of NETs，FOXM1，and IL-17 A with the Progression of MPP to Necrotizing Pneumonia in Children

doi: 10.12259/j.issn.2095-610X.S20260000

Department of Pediatrics，The First Hospital of Qinhuangdao，Qinhuangdao Hebei 066000，China

Received Date: 2026-02-02

Abstract

Abstract

Objective To investigate the correlation of serum neutrophil extracellular traps （NETs）, forkhead box protein M1 （FOXM1）, and interleukin-17 A （IL-17A） with the progression of mycoplasma pneumoniae pneumonia （MPP） to necrotizing pneumonia in children. Methods A total of 203 pediatric patients with MPP admitted to the First Hospital of Qinhuangdao from January 2023 to December 2024 were selected as the modeling set, and they were divided into a necrotizing group （n = 39） and a non-necrosis group （n = 164） based on the presence or absence of pulmonary necrosis. Another 30 children with MPP from January 2025 to March 2025 were selected as an external validation set. Baseline data, serum levels of NETs, FOXM1, and IL-17A were compared between the two groups. Pearson correlation analysis was used to assess correlations among serum NETs, FOXM1 and IL-17A. Logistic regression analysis was used to investigate the relevant influencing factors of MPP necrotic pneumonia. Receiver Operating Characteristic （ROC） curve analysis was conducted to evaluate the predictive value of conventional indicators （duration of fever, pulmonary consolidation, white blood cell count, and their combination） and serum NETs, FOXM1, IL-17A, and their combination in predicting necrotizing pneumonia in MPP. The consistency between the predictions made by the combination of NETs, FOXM1 , and IL-17A and clinical outcomes was analyzed using the Kappa analysis. Results The necrotizing group had a longer duration of fever, a higher proportion of lung consolidation, and higher white blood cell counts than the non-necrosis group （P < 0.05）. Serum levels of NETs, FOXM1, and IL-17A were significantly higher in the necrotizing group than in the non-necrotizing group （P < 0.05）. Pearson correlation analysis showed that NETs were positively correlated with FOXM1 and IL-17 A （r = 0.194, 0.216, P = 0.006, 0.002）, and FOXM1 was positively correlated with IL-17 A （r = 0.203, P = 0.004）. Logistic regression analysis showed that after adjusting for duration of fever, lung consolidation, and white blood cell counts, serum NETs, FOXM1, and IL-17A remained independent factors associated with necrotizing pneumonia in MPP （P < 0.05）. For conventional indicators, the AUC values for duration of fever, lung consolidation, white blood cell counts, and their combination in predicting necrotizing pneumonia ranged from 0.648 to 0.854 （P < 0.05）. For serum indicators, the AUC values for NETs, FOXM1, IL-17A） and their combination ranged from 0.749 to 0.941 （P < 0.05）, The AUC of the combination of conventional indicators was significantly higher than that of fever duration, lung consolidation, and white blood cell counts alone （P < 0.05）. The AUC for the combination of NETs, FOXM1, and IL-17A was significantly higher than that for any single serum indicator （P < 0.05）, and significantly higher than that for the combination of conventional indicators （P < 0.05）. Conclusion Serum NETs, FOXM1, and IL-17A are associated with the progression of MPP to necrotizing pneumonia in children. The combined detection of these three biomarkers can improve the predictive efficacy for necrotizing pneumonia.
- Neutrophil extracellular traps,
- Forkhead box protein M1,
- Interleukin-17A,
- Mycoplasmal pneumoniae pneumonia in children,
- Necrotizing pneumonia,
- Predictive efficacy

FullText(HTML)

References(25)

References

[1]	中华医学会儿科学分会呼吸学组, 国家呼吸系统疾病临床医学研究中心, 中华儿科杂志编辑委员会, 等. 儿童肺炎支原体肺炎诊断与治疗循证指南(2023)[J]. 中华儿科杂志, 2024, 62(12): 1137-1144. doi: 10.3760/cma.j.cn112140-20240722-00503
[2]	中华医学会儿科学分会新生儿学组, 《中华儿科杂志》编辑委员会. 新生儿高胆红素血症诊断和治疗专家共识[J]. 中华儿科杂志, 2014, 52(10): 745-748.
[3]	罗娟, 陈鹏, 郭宏溪, 等. 儿童肺炎支原体坏死性肺炎的危险因素及预测模型[J]. 中华实用儿科临床杂志, 2025, 40(3): 187-193.
[4]	Oliveira J D, Vieira-Damiani G, da Silva L Q, et al. Impact of antiplatelets, anticoagulants and cyclic nucleotide stimulators on neutrophil extracellular traps (NETs) and inflammatory markers during COVID-19[J]. J Thromb Thrombolysis, 2025, 58(2): 199-209.
[5]	Malamud M, Whitehead L, McIntosh A, et al. Recognition and control of neutrophil extracellular trap formation by MICL[J]. Nature, 2024, 633(8029): 442-450. doi: 10.1038/s41586-024-07820-3
[6]	董庆华, 尹建运, 苏杭, 等. 中性粒细胞胞外诱捕网在儿童重症肺炎支原体肺炎中的意义[J]. 新医学, 2024, 55(7): 520-526.
[7]	Wang P, Zhang H, Zhao W, et al. Silencing of long non-coding RNA KCNQ1OT1 alleviates LPS-induced lung injury by regulating the miR-370-3p/FOXM1 axis in childhood pneumonia[J]. BMC Pulm Med, 2021, 21(1): 247. doi: 10.1186/s12890-021-01609-0
[8]	Huang X, Zhang X, Machireddy N, et al. Endothelial FoxM1 reactivates aging-impaired endothelial regeneration for vascular repair and resolution of inflammatory lung injury[J]. Sci Transl Med, 2023, 15(709): eabm5755. doi: 10.1126/scitranslmed.abm5755
[9]	Jiang J, Sun L, Huang M. Abnormal Changes in IL-13 and IL-17A Serum Levels in Children with Adenovirus Pneumonia and their Diagnostic Value[J]. Iran J Immunol, 2024, 21(1): 81-88.
[10]	Wang H, Zhang Y, Zhao C, et al. Serum IL-17A and IL-6 in paediatricMycoplasma pneumoniaepneumonia: Implications for different endotypes[J]. Emerg Microbes Infect, 2024, 13: 2324078.
[11]	中华人民共和国国家卫生健康委员会, 赵顺英, 钱素云, 等. 儿童肺炎支原体肺炎诊疗指南(2023年版)[J]. 国际流行病学传染病学杂志, 2023, 50(2): 79-85.
[12]	白新凤, 徐梅先. 儿童肺炎支原体坏死性肺炎预测指标[J]. 国际呼吸杂志, 2023, 43(9): 1083-1088. doi: 10.3760/cma.j.issn.1673-4912.2026.01.009
[13]	王芸飞, 李燕. 中性粒细胞胞外诱捕网在脓毒症病理生理及临床应用中的研究进展[J]. 安徽医药, 2024, 28(4): 637-643.
[14]	Yang L, Zhang C, Liu Y, et al. The therapeutic potential of neutrophil extracellular traps and NLRP3 inflammasomes in Mycoplasma pneumoniae pneumonia[J]. Immunol Investig, 2024, 53(6): 975-988. doi: 10.1080/08820139.2024.2364796
[15]	李星, 叶林, 赵磊, 等. 重症肺炎患者多药耐药菌感染病原学及NETs和IL-17与TGF-β诊断价值[J]. 中华医院感染学杂志, 2024, 34(7): 973-977.
[16]	杨晓琳, 任冲, 杨妍. 外周血cf-DNA/NETs水平与重症肺炎患儿转归不良的关系分析[J]. 东南大学学报(医学版), 2025, 44(1): 66-72. doi: 10.3969/j.issn.1671-6264.2025.01.012
[17]	Meier A, Sakoulas G, Nizet V, et al. Neutrophil extracellular traps: An emerging therapeutic target to improve infectious disease outcomes[J]. J Infect Dis, 2024, 230(2): 514-521. doi: 10.1093/infdis/jiae252
[18]	商焕霞, 倪为波, 席素雅, 等. 血清FOXM1和PD-L1在老年重症肺炎早期诊断及预后评估中的预测价值[J]. 临床和实验医学杂志, 2023, 22(24): 2608-2612. doi: 10.3969/j.issn.1671-4695.2023.24.009
[19]	安伟乔, 张绍义, 范红娟, 等. 老年心力衰竭并发肺炎患者血清FOXM1和IGF2表达水平及与预后价值研究[J]. 现代检验医学杂志, 2024, 39(2): 146-150.
[20]	张薇, 王丹丹, 梁丹丹, 等. 不同严重程度肺炎支原体感染患儿血清TIMP3、STAT3和FOXM1表达及意义[J]. 免疫学杂志, 2024, 40(11): 839-843+855. doi: 10.13431/j.cnki.immunol.j.20240117
[21]	Bu M L, Li M H, Feng M, et al. Poly(I: C) exacerbates airway goblet cell hyperplasia and lung inflammation in HDM-exposed balb/C mice by YAP/FOXM1 pathway[J]. Int Arch Allergy Immunol, 2023, 184(7): 707-719. doi: 10.1159/000529109
[22]	Goates M, Shrestha A, Thapa S, et al. Blocking IL-17a signaling decreases lung inflammation and improves alveolarization in experimental bronchopulmonary dysplasia[J]. Am J Pathol, 2024, 194(11): 2023-2035. doi: 10.1016/j.ajpath.2024.07.011
[23]	Long X, Xie J, Ren L, et al. IL-17A plays a critical role in RSV infection in children and mice[J]. Virol J, 2023, 20(1): 30. doi: 10.1186/s12985-023-01990-8
[24]	Khalaf Q A, Rasool K H, Naji E N. Evaluation of IL-6 and IL-17A gene polymorphisms in Iraqi patients infected with COVID-19 and type 2 diabetes mellitus[J]. Hum Antibodies, 2023, 31(3): 35-44. doi: 10.3233/HAB-230007
[25]	Luo Y, Li C, Zhou Z, et al. Biological functions of IL-17-producing cells in Mycoplasma respiratory infection[J]. Immunology, 2021, 164(2): 223-230. doi: 10.1111/imm.13346

Relative Articles(20)

Relative Articles

[1]	Mengjiao ZHAO, Yanni JU. Correlation Between Serum NF-κB，S1P1，and SOCS3 Levels and Disease Severity in Children with Bacterial Infectious Pneumonia，and Their Prognostic Predictive Value. Journal of Kunming Medical University,
[2]	Li YOU, Ning LI, Yunjun GAO, Yongsheng LI, Yafeng WU, Jiansheng LI. Construction of An Early Warning Model for Upper Gastrointestinal Bleeding in Patients with Cirrhotic Portal Hypertension Based on Serum miR-140 and miR-335-5p Combined with Clinical Indicators. Journal of Kunming Medical University,
[3]	Dongliang GUO, Dehui LI, Na WANG. Expression Levels of t-PA，TN-C and Cav-1 in Patients with Different Clinical Outcomes after Decompressive Craniectomy for Massive Cerebral Infarction. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20260314
[4]	Xiaowei LI, Kai YANG, Fanrong WANG, Xu LIU. Evaluative Value of Serum TNFSF14，TLR7，and sCD14-ST Levels in Assessing Disease Severity and Prognosis of Respiratory Syncytial Virus Infection-related Pneumonia in Children. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20251211
[5]	Hongyan CUI, Shuyang ZHANG, Wenwen ZHOU. Application of Serum STAT3，HDAC2，and Del-1 Levels in the Evaluation of Disease Severity and Prognosis of Children with Respiratory Syncytial Virus Pneumonia. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20251116
[6]	Wendi YANG, Yaxin WANG, Jing QIAN, Limin YIN, Fengting MU, Xiaoli ZHAO. Clinical Application of NETs in Diagnosis and Monitoring of Acute Ischemic Stroke. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20251012
[7]	Baixue LIN, Lei ZHANG, Mingzhu GAO, Haimei SUN, Lifang YE, Ying WANG, Chan REN, Xiaorong YANG. Diagnostic Value of SIRI for Acute Ischemic Stroke-Associated Pneumonia of the Brain. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240513
[8]	Xiaoli SHANG, Junxue NI, Yeying WANG, Jiao SHAN, Na BAI, Song WANG. Clinical Epidemiological Characteristics of Mycoplasma Pneumoniae and Its Correlation with Climatic Environment. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230618
[9]	Ling HE, Zehao YU. Correlation between CD3⁺ HLA-DR Expression and Vita Level in Severe Mycoplasma Pneumoniae Pneumonia. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20220528
[10]	Song-tao BIN, Ming LI, Li TAN, Cheng-qing WU, Ji WANG, Xiao-qin HU. Clinical Analysis of 46 Children with Necrotizing Pneumonia. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210102
[11]	Gong Ying Feng . . Journal of Kunming Medical University,
[12]	Ding Zhen Bo , Duan Jing , Lu Ping , Huang Yong Kun , Zhao Ya Ling , Luo Yan . . Journal of Kunming Medical University,
[13]	Sun Yu Xing , Tan Li , Hao Rui , Li Ming , Gan Zheng Yan , Wu Cheng Qing . The Correlation between Exhaled Nitric Oxide and Mycoplasma Pneumoniae Pneumonia in Children. Journal of Kunming Medical University,
[14]	Luo Yang . Curative Effect of Tanreqing Injection Combined with Ganciclovir in the Treatment of Pediatric Respiratory Syncytial Virus Pneumonia. Journal of Kunming Medical University,
[15]	Tan Li . Levels of Interleukin-4，Interleukin-6 and Interferon-gamma in Bronchoalveolar Lavaga Fluid of Children with Refractory Mycoplasma Pneumoniae Pneumonia and the Features of Bronchoscopy. Journal of Kunming Medical University,
[16]	Tian Yun Fen . Epidemiological Analysis of Mycoplasma Pneumoniae Infection in Children in Kunming. Journal of Kunming Medical University,
[17]	He Li Yun . . Journal of Kunming Medical University,
[18]	. . Journal of Kunming Medical University,
[19]	. Effects of the Guideline of Community-aquired Pneumonia on the Achievement Ratio of CAP Therapy. Journal of Kunming Medical University,
[20]	Yang Ji Ying . . Journal of Kunming Medical University,