血清sCD163、CCL18表达在支气管哮喘患儿病情监测及预后预测中的价值

Clinical values of serum sCD163 and CCL18 expressions for evaluating disease severity and predicting prognosis of children with bronchial asthma

摘要

目的 探究血清中可溶性血红蛋白清道夫受体163(sCD163)、CC趋化因子配体18(CCL18)表达水平对支气管哮喘(BA)患儿病情严重程度的影响及预测预后的临床作用。方法 选取2021年1月至2022年1月期间在衡水市人民医院收治的120例BA患儿记为BA组,根据病情严重程度分为轻度组(34例)、中度组(62例)、重度组(24例),根据预后情况将BA组患儿分为预后良好组(52例)、预后不良组(68例);同时随机选取120例本院体检健康儿童为对照组.酶联免疫吸附实验(ELISA)检测sCD163、CCL18水平;肺功能仪检测受试者呼吸峰流量(PEF)百分比和第一秒用力呼气量容积(FEV₁);Pearson相关性分析sCD163、CCL18相关性;多因素Logistic回归分析BA患儿预后不良的影响因素;受试者工作特征(ROC)曲线评估CD163、CCL18对BA患儿预后不良的预测价值。结果 BA组患儿血清中sCD163、CCL18表达水平高于对照组,PEF、FEV₁低于对照组,差异有统计学意义(t值介于8.082~10.896之间,P<0.05);轻度组、中度组和重度组患儿血清中sCD163、CCL18表达水平依次升高,差异有统计学意义(F值分别为14.378、38.191,P<0.05);预后良好组患儿血清中sCD163、CCL18表达水平低于预后不良组,PEF、FEV₁高于预后不良组,差异有统计学意义(t值介于5.576~8.295之间,P<0.05);Logistic回归分析结果显示,血清中sCD163、CCL18表达水平是BA患儿预后不良的独立危险因素(OR值分别1.587、1.826,P<0.05),PEF、FEV₁是BA患儿预后不良的独立保护因素(OR值分别0.527、0.425,P<0.05);Pearson相关性分析显示预后不良组患儿血清中sCD163、CCL18表达水平呈正相关性(r=0.485,P<0.001);sCD163、CCL18及二者联合预测BA患儿预后不良的曲线下面积(AUC)分别为0.825(95%CI:0.752~0.897)、0.841(95%CI:0.774~0.909)、0.906(95%CI:0.856~0.955),二者联合预测优于单独预测(Z值分别为2.454、2.779,P<0.05)。结论 随着BA患儿病情严重程度的增加,血清中sCD163、CCL18表达水平逐渐升高,sCD163、CCL18联合预测BA患儿预后不良具有较高价值,可作为早期预测指标.

Abstract

Objective To investigate clinical values of expression levels of soluble cluster differentiation 163 (sCD163) and CC chemokine ligand 18 (CCL18) in serum for evaluating severity of bronchial asthma (BA) and predicting prognosis of the children with BA. Methods 120 children with BA who admitted to our hospital from January 2021 to January 2022 were selected as BA group. According to severity of the disease, they were divided into mild BA group (34 cases), moderate BA group (62 cases), and severe BA group (24 cases). Again, according to prognosis, the children in the BA group were divided into good prognosis group (52 cases) and poor prognosis group (68 case). A total of 120 healthy children who underwent physical examination in the same period were randomly selected as the control group. ELISA was applied to detect serum levels of sCD163 and CCL18, and pulmonary function test apparatus was applied to test percentage of peak expiratory flow (PEF) and forced expiratory volume in one second (FEV ₁) of the children. Pearson correlation analysis was used to analyze correlation between sCD163 and CCL18. Multivariate Logistic regression was applied to analyze influencing factors of poor prognosis of the children with BA. ROC curve was applied to evaluate predictive values of CD163 and CCL18 for poor prognosis of the children with BA. Results The serum levels of sCD163 and CCL18 of BA children were higher than those in the control group, while their PEF and FEV₁ were lower than those in the control group, and the differences were significant (t values were between 8.082 and 10.896, all P<0.05). And the serum levels of sCD163 and CCL18 of BA children in the mild BA group, the moderate BA group and the severe BA group increased successively along with increase in severity of the disease, and the differences were significant (F=14.378 and 38.191 respectively, both P<0.05). The serum levels of sCD163 and CCL18 of the children with BA in the good prognosis group were significantly lower than those in the poor prognosis group, while their PEF and FEV₁ were significantly higher than those in the poor prognosis group (T values were between 5.576 and 8.295, all P<0.05). Logistic regression analysis showed that the expression levels of sCD163 and CCL18 in serum were independent risk factors for poor prognosis of these children with BA (OR=1.587 and 1.826 respectively, both P<0.05), while PEF and FEV₁ were independent protective factors for poor prognosis of these children with BA (OR=0.527 and 0.425 respectively, both P<0.05). Pearson correlation analysis showed that in the poor prognosis group the serum expression level of sCD163 was positively correlated with the serum expression level of CCL18 (r=0.485, P<0.001). The AUCs of sCD163, CCL18 and their combination for predicting poor prognosis of these children with BA were 0.825 (95%CI: 0.752-0.897), 0.841 (95%CI: 0.774-0.909) and 0.906 (95%CI: 0.856-0.955) respectively, indicating that the combied prediction of the two indexes was superior to those of their single prediction (Z=2.454 and 2.779 respectively, both P<0.05). Conclusion In these children with BA, as severity of BA increases, the expression levels of sCD163 and CCL18 in serum gradually increase. The combination of sCD163 and CCL18 has high value for predicting poor prognosis of BA children, so they can be used as early diagnostic indicators of the disease.

关键词

支气管哮喘 / 患儿 / 可溶性血红蛋白清道夫受体163 / CC趋化因子配体18 / 预后

Key words

bronchial asthma / children / soluble cluster differentiation 163 / CC chemokine ligand 18 / prognosis

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基金资助

2023年度河北省医学科学研究课题(20232077)