血清前列腺素D2和白细胞相关免疫球蛋白样受体Ｇ1的表达对儿童急性呼吸窘迫综合征诊断及预后的意义

Diagnostic and prognostic significance of expressions of serum prostaglandin D2 and LAIRＧ1 for acute respiratory distress syndrome in children

摘要

目的 探讨急性呼吸窘迫综合征(ARDS)患儿血清前列腺素D2(PGD2)、白细胞相关免疫球蛋白样受体Ｇ1(LAIRＧ1)的表达对疾病诊断及预后的意义。方法 选取2021年10月至2023年10月大冶市人民医院收治的80例2~8岁ARDS患儿为研究对象(观察组),选择同期同年龄段体检健康的94例儿童为对照组;应用酶联免疫吸附法(ELISA)检测观察组和对照组患儿血清PGD2、LAIRＧ1水平,采用受试者工作特征(ROC)曲线分析血清PGD2、LAIRＧ1对儿童发生ADRS的诊断价值;随访患儿的预后状况,并将其分为生存组65例与死亡组15例;比较观察组与对照组、生存组与死亡组的一般资料及血清PGD2、LAIRＧ1水平,采用多因素Logistic回归分析ADRS患儿预后的影响因素。结果 观察组血清PGD2、LAIRＧ1水平与对照组比较,差异均有统计学意义(t值分别为7．436、7．945,P＜0．05).ROC曲线分析显示,血清PGD2、LAIRＧ1单独及联合诊断儿童发生ARDS的曲线下面积(AUC)分别为0．794、0．785、0．873,二者联合诊断优于PGD2、LAIRＧ1各自单独诊断效能(Z值分别为3．302、3．161,P＜0．05).生存组机械通气时间、小儿危重病例评分(PCIS)、氧合指数(OI)及血清PGD2和LAIRＧ1水平与死亡组比较,差异均有统计学意义(t值分别为6．921、2．620、15．325、2．686、5．225,P＜0．05).多因素Logistic回归分析显示,PGD2(OR＝2．335,95％CI:1．713~3．183)、LAIRＧ1(OR＝2．562,95％CI:1．451~4．523)均是ARDS患儿28d发生死亡的危险因素(P＜0．05)。结论 ARDS患儿血清PGD2、LAIRＧ1水平均有升高,二者联合检测对儿童发生ARDS具有一定的诊断价值,且与患儿的预后有关联.

Abstract

Objective To explore diagnostic and prognostic significance of serum prostaglandin D2 (PGD2) and leukocyte associated immunoglobulin like receptor Ｇ1 (LAIRＧ1) expressions for acute respiratory distress syndrome (ARDS) in children. Methods 80 children aged 2-8 years with ARDS who admitted to Daye Municipal People's Hospital from October 2021 to October 2023 were selected as observation group, and 94 healthy age-matched children who underwent physical examinations in the same period were as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect expression levels of PGD2 and LAIRＧ1 in serum of the children in the control group and the observation group. Receiver operating characteristic (ROC) curve was applied to analyze diagnostic values of serum PGD2 and LAIRＧ1 levels for occurrence of ADRS in children. The children with ARDS were followed up, and according to prognosis of the children at the follow-up, the children were divided into survival group (n=65) and death group (n=15). General information and serum levels of PGD2 and LAIRＧ1 of the children were compared between the two groups. Multivariate Logistic regression was applied to analyze factors affecting prognosis of the children with ADRS. Results Compared with the control group, the serum levels of PGD2 and LAIRＧ1 of the children with ARDS in the observation group increased, and the differences were significant (t=7.436 and 7.945 respectively, both P<0.05). The areas under the curve (AUCs) of serum PGD2 alone, LAIRＧ1 alone and combination of the two indexes for predicting occurrence of ARDS in children were 0.794, 0.785 and 0.873 respectively, indicating that the diagnostic efficacy of combination of the two was superior to those of single PGD2 and single LAIRＧ1 alone (Z=3.302 and 3.161 respectively, both P<0.05). There were no statistically significant differences in age, gender, admission weight, arterial carbon dioxide pressure (PaCO₂) and arterial oxygen pressure (PaO₂) between the survival group and the death group (all P>0.05). The mechanical ventilation time, oxygenation index (OI), and serum PGD2 and LAIRＧ1 levels of the children with ARDS in the survival group were shorter and lower than those in the death group, while their pediatric critical illness score (PCIS score) was higher than that in the death group, and the differences were significant (t=6.921, 15.325, 2.686, 5.225 and 2.620 respectively, all P<0.05). Multivariate Logistic regression analysis shown that PGD2 and LAIRＧ1 were both risk factors for 28-day death in children with ARDS (for PGD2: OR=2.335, 95%CI: 1.713-3.183; for LAIRＧ1: OR=2.562, 95%CI: 1.451-4.523, both P<0.05). Conclusion The serum levels of PGD2 and LAIRＧ1 elevate in children with ARDS, the combined detection of the two has certain diagnostic value for occurrence of ARDS and they are related to prognosis of the children with ARDS.

关键词

急性呼吸窘迫综合征 / 患儿 / 前列腺素D2 / 白细胞相关免疫球蛋白样受体Ｇ1 / 诊断 / 预后

Key words

acute respiratory distress syndrome / children / prostaglandin D2 / leukocyte associated immunoglobulin like receptor Ｇ1 / diagnosis / prognosis

参考文献

[1] 许千金, 朱鹏, 石钟山, 等. 急性呼吸窘迫综合征呼吸驱动:评估与控制[J]. 中华医学杂志, 2022, 102(36): 2839-2843.

[2] Dassios T, Williams E E, Kaltsogianni O, et al. Permissive hypercapnia and oxygenation impairment in premature ventilated infants[J]. Respir Physiol Neurobiol, 2023, 317(1): 1-12.

[3] 冯瑾. 成人支气管哮喘、慢性阻塞性肺疾病患者血清前列腺素D2水平的差异及临床意义[D]. 承德: 承德医学院, 2022.

[4] Helou D G, Quach C, Hurrell B P, et al. LAIR-1 limits macrophage activation in acute inflammatory lung injury[J]. Mucosal Immunol, 2023, 9(1): 1-12.

[5] Rotta A T, Piva J P, Andreolio C, et al. Progress and perspectives in pediatric acute respiratory distress syndrome[J]. Rev Bras Ter Intensiva, 2015, 27(3): 266-273.

[6] Moharana S, Jain D, Bhardwaj N, et al. Pressure support ventilation decreases propofol consumption and improves postoperative oxygenation index compared with pressure-controlled ventilation in children undergoing ambulatory surgery: a randomized controlled trial[J]. Can J Anaesth, 2020, 67(4): 445-451.

[7] Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference[J]. Pediatr Crit Care Med, 2015, 16(5): 428-439.

[8] Meyer N J, Gattinoni L, Calfee C S. Acute respiratory distress syndrome[J]. Lancet, 2021, 398(10300): 622-637.

[9] 陈若红, 冯业成, 黄惠敏, 等. 儿童肺部感染并发急性呼吸窘迫综合征影响因素分析[J]. 中国妇幼健康研究, 2022, 33(5): 67-71.

[10] 梁珍花, 庞小容, 张健. 儿童急性呼吸窘迫综合征研究进展[J]. 中国保健营养, 2020, 30(15): 384-385.

[11] Domingo C, Palomares O, Sandham D A, et al. The prostaglandin D2 receptor 2 pathway in asthma: a key player in airway inflammation[J]. Respir Res, 2018, 19(1): 1-8.

[12] Rittchen S, Rohrer K, Platzer W, et al. Prostaglandin D2 strengthens human endothelial barrier by activation of E-type receptor 4[J]. Biochem Pharmacol, 2020, 182(1): 1-16.

[13] Jandl K, Stacher E, Bálint Z, et al. Activated prostaglandin D2 receptors on macrophages enhance neutrophil recruitment into the lung[J]. J Allergy Clin Immunol, 2016, 137(3): 833-843.

[14] Laidlaw T M. Pathogenesis of NSAID-induced reactions in aspirin-exacerbated respiratory disease[J]. World J Otorhinolaryngol Head Neck Surg, 2018, 4(3): 162-168.

[15] Zhang J, Zhang Y, Cheng S, et al. LAIR-1 overexpression inhibits epithelial-mesenchymal transition in osteosarcoma via GLUT1-related energy metabolism[J]. World J Surg Oncol, 2020, 18(1): 1-10.

[16] Helou D G, Shafiei-Jahani P, Hurrell B P, et al. LAIR-1 acts as an immune checkpoint on activated ILC2s and regulates the induction of airway hyperreactivity[J]. J Allergy Clin Immunol, 2022, 149(1): 223-236.

[17] Kumawat K, Geerdink R J, Hennus M P, et al. LAIR-1 limits neutrophilic airway inflammation[J]. Front Immunol, 2019, 10(1): 223-236.

基金资助

黄石市卫生健康委员会科研项目(WJ2021F023)