Correlation analysis of blood glucose elevation following glucocorticoid treatment in children with pneumoniae pneumonia and levels of miR-21, miR-221, and T-Lymphocyte subsets.

BACKGROUND

Glucocorticoid (GC) treatment for children with refractory Mycoplasma pneumoniae pneumonia (RMPP) often induces hyperglycemia, with no predictive methods.

OBJECTIVES

This study aims to analyze the relationships between hyperglycemia and inflammatory markers, microRNAs, and T-lymphocyte subsets.

METHODS

A retrospective cohort and case-control study was conducted on pediatric RMPP patients treated from March 2022 to February 2025. Patients were initially divided into an antibiotics-only group and a GC treatment group for cohort comparison. Within the GC group, patients were further categorized into normoglycemic and hyperglycemic groups based on whether they developed hyperglycemia (fasting glucose ≥7.0 mmol/L or random glucose ≥11.1 mmol/L) within 7 days. BMI-Z scores and HOMA-IR were assessed. Blood samples collected before treatment and on days 1, 3, and 7 were analyzed for miR-21, miR-221, T-lymphocyte subsets, and inflammatory cytokine levels.

RESULTS

In the cohort analysis, GC treatment significantly increased the incidence of hyperglycemia compared to antibiotics alone (41.08% vs. 0.43%, P < 0.001). In the GC-treated cohort, post-treatment BMI-Z (0.98 vs. 0.72, P < 0.001) and HOMA-IR (2.28 vs. 1.92, P < 0.001) were significantly higher in the hyperglycemic group. By day 7, miR-21 and miR-221 levels were higher (1.69 vs. 1.51, P = 0.001), while CD3+ T-cell percentages were lower (47.75% vs. 48.92%, P = 0.002) in the hyperglycemic group. Multivariate analysis identified higher BMI-Z (OR=2.121), HOMA-IR (OR=11.378), miR-21 (OR=3.544), miR-221 (OR=3.040), and lower CD3+ (OR=0.837) as independent predictors.

CONCLUSION

BMI-Z, HOMA-IR, miR-21, and miR-221 elevations, along with a reduction in CD3+ T cells, were important independent predictors of GC-induced hyperglycemia in children with RMPP.