热性惊厥患儿血清GDF-15及NT-3表达与病情相关性

Correlations of expressions of growth differentiation factor-15 and neurotrophic factor-3 in serum of children with febrile convulsion with severity of the disease

摘要

目的 探讨生长分化因子-15(GDF-15)和神经营养因子-3(NT-3)在热性惊厥患儿血清中的表达及其与病情严重程度的相关性。方法 选取2020年6月至2022年12月在我院收治的91例热性惊厥患儿作为研究对象.以热性惊厥患儿发作次数、持续时间、发作形式,将其分为单纯组(52例)和复杂组(39例),另外选取91例同期体检的健康儿童作为健康对照组.采用酶联免疫吸附(ELISA)法检测血清GDF-15、NT-3水平;采用Pearson法分析热性惊厥患者不同病情程度热性惊厥患儿与GDF-15、NT-3水平相关性;采用Logistic回归法分析影响热性惊厥患儿病情严重程度的危险因素;采用受试者工作特征(ROC)曲线分析GDF-15、NT-3水平对热性惊厥患儿病情严重程度的诊断价值。结果 热性惊厥组血清GDF-15和NT-3水平显著高于健康对照组(t=7.742、7.624,P<0.001).与健康对照组相比,单纯组和复杂组热性惊厥患儿GDF-15和NT-3水平均显著升高(F=6.125、10.214,P<0.01);与单纯组相比,复杂组热性惊厥患儿GDF-15和NT-3水平均显著升高(q=8.312、9.164,P<0.01).热性惊厥患儿病情严重程度(单纯和复杂)与GDF-15、NT-3水平均表现出正相关(r=0.604、0.724,P<0.001).与惊厥持续时间≤15min的热性惊厥患儿相比,惊厥持续时间>15min的热性惊厥患儿的GDF-15及NT-3水平显著上升(t=2.436、3.180,P<0.05).与单纯组热性惊厥患儿相比,复杂组CRP及WBC水平更高(t=8.253、8.146,P<0.05).影响热性惊厥患儿病情严重程度的独立危险因素为GDF-15、NT-3(OR=2.889、2.125,P<0.05).GDF-15、NT-3以及二者联合诊断热性惊厥患儿病情严重程度的ROC曲线下面积(AUC)分别为0.855、0.833和0.950,GDF-15、NT-3联合诊断效能高于单独检测效能(Z=2.015,P=0.043;Z=2.198,P=0.028)。结论 血清GDF-15、NT-3水平升高与热性惊厥患儿病情严重程度呈正相关.GDF-15、NT-3及二者联合对热性惊厥患儿病情严重程度均具有预测价值,可能作为热性惊厥患儿病情严重程度的诊断生物标志物.

Abstract

Objective To investigate expressions of growth differentiation factor-15 (GDF-15) and neurotrophic factor-3 (NT-3) in serum of children with febrile convulsion and their correlations with severity of the disease. Methods A total of 91 children with febrile convulsion who admitted to our hospital from June 2020 to December 2022 were selected as study subjects. According to frequency, duration and form of seizures of the children with febrile convulsion, they were divided into simple febrile convulsion group (52 cases) and complex febrile convulsion group (39 cases). Other 91 healthy children who underwent physical examination were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of GDF-15 and NT-3. Pearson correlation analysis was applied to analyze correlations of serum GDF-15 and NT-3 levels with severity of febrile convulsion in children. Logistic regression analysis was applied to analyze risk factors affecting severity of febrile seizures in children. Receiver operating characteristic (ROC) curve was applied to analyze diagnostic values of GDF-15 and NT-3 levels for severity of febrile seizures in children. Results The serum levels of GDF-15 and NT-3 in the febrile convulsion group were significantly higher than those in the control group (t=7.742 and 7.624 respectively, both P<0.001). Compared with the control group, the serum levels of GDF-15 and NT-3 of these children with febrile convulsion in both the simple febrile convulsion and the complex febrile convulsion group significantly elevated (F=6.125 and 10.214 respectively, both P<0.01). Compared with the simple febrile convulsion group, the serum levels of GDF-15 and NT-3 of these children with febrile convulsion in the complex febrile convulsion group significantly elevated (q=8.312 and 9.164 respectively, both P<0.01). The serum GDF-15 and NT-3 levels were positively correlated with severity of febrile seizures (including simple and complex febrile convulsions) in children (r=0.604 and 0.724, respectively, both P<0.001). Compared with the children who had febrile seizures lasting for ≤15 minutes, the children who had febrile seizures lasting for >15 minutes had significantly higher serum levels of GDF-15 and NT-3 (t=2.436 and 3.180 respectively, both P<0.05). Compared with the simple febrile convulsion group, the serum C-reactive protein (CRP) and white blood cell count (WBC) levels of the children in the complex febrile convulsion group were significantly higher (t=8.253 and 8.146 respectively, both P<0.05). Logistic regression analysis shown that the serum levels of GDF-15 and NT-3 were independent risk factors affecting severity of febrile seizures in children (OR=2.889 and 2.125 respectively, both P<0.05). The areas under the curve (AUCs) of GDF-15, NT-3 and combination of the two indexes for diagnosing severity of febrile seizures in children were 0.855, 0.833 and 0.950 respectively, the combined diagnostic efficacy of GDF-15 and NT-3 was higher than those of single GDF-15 and single NT-3 alone (Z=2.015, P=0.043; Z=2.198, P=0.028). Conclusion Serum GDF-15 and NT-3 levels are positively correlated with severity of febrile convulsion in children. GDF-15, NT-3 and their combination have predictive values for severity of febrile convulsion, and they can be used as diagnostic biomarkers for severity of febrile convulsion in children.

关键词

患儿 / 热性惊厥 / 生长分化因子-15 / 神经营养因子-3

Key words

children / febrile convulsion / growth differentiation factor-15 / neurotrophin-3

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基金资助

2022年度河北省医学科学研究课题计划项目(20221747)