支气管哮喘合并肺炎支原体感染患儿血清CXCL8、CCSP水平变化及其与血清炎症因子、肺功能的关系

Changes in serum CXCL8 and CCSP levels in children with bronchial asthma complicated by mycoplasma pneumoniae infection and the relationship with serum inflammatory factors and lung function

摘要

目的 探讨支气管哮喘合并肺炎支原体感染患儿血清CXC趋化因子配体8(CXCL8)、Clara细胞分泌蛋白(CCSP)水平变化及其与血清炎症因子、肺功能的关系。方法 选取2021年11月至2023年8月于宜昌市儿童医院收治的支气管哮喘合并肺炎支原体感染患儿80例为合并肺炎组,另选取单纯支原体哮喘患儿58例为单纯哮喘组,及同期体检的健康志愿者52例为对照组,采用酶联免疫吸附试验(ELISA)检测血清CXCL8、CCSP水平,收集分析患者一般临床资料,检测患者肺功能相关指标以及炎症因子水平;使用Pearson法分析血清CXCL8、CCSP与炎症因子以及肺功能指标相关性;绘制受试者工作特征(ROC)曲线分析血清CXCL8、CCSP对支气管哮喘合并肺炎支原体感染的诊断价值。结果 与对照组相比,单纯哮喘组和合并肺炎组患者血清CXCL8水平升高、CCSP水平降低(F值为545.035、584.178,P<0.05),且与单纯哮喘组相比,合并肺炎组患者血清CXCL8水平升高、CCSP水平降低(t值为27.950、19.075,P<0.05);与单纯哮喘组相比,合并肺炎组患者的炎症因子水平升高(t值介于7.945~14.701之间,P<0.05);合并肺炎组与单纯哮喘组不同年龄段患儿的肺功能指标之间差异具有统计学意义(t值介于2.915~16.967之间,P<0.05);CXCL8与炎症因子,以及5Hz、20Hz时气道黏性阻力(R5、R20)、5Hz时的气道弹性阻力(X5)、共振频率、呼吸频率(RR)均呈正相关(r值介于0.403~0.468之间,P<0.05),与每公斤体重潮气量(VT/kg)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)以及第1秒用力呼气容积(FEV₁)、第1秒用力呼气容积/用力肺活量(FEV₁/FVC)、最大呼气流量(PEF)均呈负相关(r值介于-0.527~-0.402之间,P<0.05);CCSP与炎症因子,肺功能指标(R5、R20、X5、共振频率、RR)均呈负相关(r值介于-0.487~-0.401之间,P<0.05),与肺功能指标(FEV₁、FEV₁/FVC、PEF、VT/kg、TPTEF/TE、VPEF/VE)均呈正相关(r值介于0.406~0.516之间,P<0.05);血清CXCL8、CCSP以及两者联合诊断支气管气喘合并肺炎支原体感染的曲线下面积(AUC)分别为0.826、0.818、0.909,联合诊断显著优于CXCL8(Z=2.515,P=0.012)、CCSP(Z=2.889,P=0.004)单独诊断。结论 在支气管哮喘合并肺炎支原体感染患儿中,血清CXCL8水平升高,CCSP水平降低,且二者与炎症因子和肺功能指标存在相关性。CXCL8联合CCSP对支气管气喘合并肺炎支原体感染有良好的预测价值。

Abstract

Objective To investigate the changes in serum levels of CXC chemokine ligand 8 (CXCL8) and Clara cell secretory protein (CCSP) in children with bronchial asthma complicated by Mycoplasma pneumoniae infection and their relationship with serum inflammatory factors and lung function. Methods A total of 80 children with bronchial asthma complicated by Mycoplasma pneumoniae infection admitted to Yichang Children's Hospital from November 2021 to August 2023 were included as the pneumonia group. Additionally, 58 children with Mycoplasma pneumoniae-induced asthma were included as the simple asthma group, and 52 healthy volunteers undergoing physical examination during the same period were selected as the control group. Serum CXCL8 and CCSP levels were measured using enzyme-linked immunosorbent assay (ELISA). General clinical data were collected, and lung function indices and inflammatory factor levels were evaluated. Pearson correlation analysis was used to assess the relationship between serum CXCL8 and CCSP levels with inflammatory factors and lung function indices. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic value of serum CXCL8 and CCSP for bronchial asthma complicated by Mycoplasma pneumoniae infection. Results Compared with the control group, serum CXCL8 levels were higher and CCSP levels were lower in both the simple asthma group and the pneumonia group (F=545.035 and 584.178, respectively, P<0.05). Moreover, compared with the simple asthma group, the pneumonia group had higher CXCL8 levels and lower CCSP levels (t=27.950 and 19.075, respectively, P<0.05). Inflammatory factor levels in the pneumonia group were significantly higher than those in the simple asthma group (t ranged from 7.945 to 14.701, P<0.05). Significant differences in lung function indices were observed between different age groups in the pneumonia and simple asthma groups (t ranged from 2.915 to 16.967, P<0.05). CXCL8 levels were positively correlated with inflammatory factors, airway viscous resistance at 5Hz and 20Hz (R5, R20), airway elastic resistance at 5Hz (X5), resonance frequency, and respiratory rate (RR) (r ranged from 0.403 to 0.468, P<0.05). CXCL8 levels were negatively correlated with tidal volume per kilogram body weight (VT/kg), time to peak tidal expiratory flow as a percentage of total expiratory time (TPTEF/TE), volume to peak expiratory flow as a percentage of exhaled volume (VPEF/VE), forced expiratory volume in 1 second (FEV₁), FEV₁/forced vital capacity (FVC), and peak expiratory flow (PEF) (r ranged from -0.527 to -0.402, P<0.05). CCSP levels were negatively correlated with inflammatory factors, R5, R20, X5, resonance frequency, and RR (r ranged from -0.487 to -0.401, P<0.05) and positively correlated with FEV₁, FEV₁/FVC, PEF, VT/kg, TPTEF/TE, and VPEF/VE (r ranged from 0.406 to 0.516, P<0.05). The area under the curve (AUC) for serum CXCL8, CCSP, and their combined diagnosis of bronchial asthma complicated by Mycoplasma pneumoniae infection was 0.826, 0.818, and 0.909, respectively. The combined diagnosis was significantly better than CXCL8 (Z=2.515, P=0.012) or CCSP (Z=2.889, P=0.004) alone. Conclusion In children with bronchial asthma complicated by Mycoplasma pneumoniae infection, serum CXCL8 levels are elevated, and CCSP levels are reduced. Both are correlated with inflammatory factors and lung function indices. The combination of CXCL8 and CCSP has good predictive value for bronchial asthma complicated by Mycoplasma pneumoniae infection.

关键词

支气管哮喘 / 肺炎支原体感染 / CXC趋化因子配体8 / Clara细胞分泌蛋白 / 炎症因子 / 肺功能 / 儿童

Key words

bronchial asthma / Mycoplasma pneumoniae infection / CXC chemokine ligand 8 / Clara cell secreted protein / inflammatory factor / lung function / child

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基金资助

2024年度宜昌市医疗卫生研究项目(A24G2G064)