支气管哮喘患儿血清Sema7a、ActivinA与气道重塑的相关性

Correlation between serum Sema7a, Activin A and airway remodeling in children with bronchial asthma

摘要

目的 分析支气管哮喘患儿血清信号素7a(Sema7a)、激活素A(Activin A)与气道重塑的相关性。方法 选取2022年5月至2024年5月于华北医疗健康集团峰峰总医院治疗的118例哮喘患儿为研究组(气道重塑组56例,非气道重塑组62例),79例同期健康儿童为对照组.检测并收集两组患儿肺功能和气道重塑指标,使用ELISA法检测血清Sema7a和Activin A水平,Pearson法分析气道重塑组哮喘患儿血清Sema7a和Activin A水平之间及与肺功能和气道重塑指标的关系,Logistic回归分析哮喘患儿气道重塑发生的影响因素,受试者工作特征(ROC)曲线评估血清Sema7a和Activin A水平诊断哮喘患儿气道重塑的效能。结果 研究组患儿血清Sema7a和Activin A水平显著高于对照组(t=15.648、17.357,P<0.05),中、重度组哮喘患儿显著高于轻度组,重度组哮喘患儿显著高于中度组(F=47.312、30.019,P<0.05).气道重塑组哮喘患儿的气道壁厚度与气道腔外径比(T/D)、气道管壁面积(WA)占气道总面积百分比(WA%)、Sema7a和Activin A水平显著高于非气道重塑组(t=6.955、4.142、8.722、7.327,P<0.05),呼气流量峰值(PEF)和用力呼气容积与用力肺活量之比(FEV₁/FVC)显著低于气道重塑组(t=3.609、5.041,P<0.05).Pearson结果显示,气道重塑组哮喘患儿血清Sema7a和Activin A水平呈正相关(r=0.516,P<0.05),二者与PEF和FEV₁/FVC呈负相关(r=-0.502、-0.469、-0.432、-0.540,P<0.05),与T/D和WA%呈正相关(r=0.488、0.354、0.421、0.378,P<0.05).Logistic回归表明,PEF、FEV₁/FVC、T/D、WA%、Sema7a和Activin A为哮喘患儿气道重塑的影响因素(OR=0.667、0.551、1.492、1.935、1.589、2.367,P<0.05).ROC曲线表明,血清Sema7a和Activin A水平诊断哮喘患儿气道重塑的ROC曲线下面积(AUC)分别为0.861和0.833,二者联合诊断的AUC为0.941,显著高于各自单独诊断(Z_{二者联合-Sema7a}=2.028,P=0.043;Z_{二者联合-ActivinA}=2.568,P=0.010)。结论 哮喘气道重塑患儿血清Sema7a和Activin A水平显著升高,与肺功能和气道重塑指标相关,二者联合检测诊断哮喘患儿气道重塑效能良好.

Abstract

Objective To analyze correlations of serum semaphorin 7a (Sema7a) and Activin A with airway remodeling in children with bronchial asthma. Methods From May 2022 to May 2024, 118 children with asthma treated in our hospital were selected as study group. According to severity of asthma, 49 children with asthma were divided into mild asthma group, 38 children with asthma were divided into moderate asthma group and 31 children with asthma were divided into severe asthma group. Further, according to whether the child presented with airway remodeling in pathological examination, 56 children with asthma who presented with airway remodeling were divided into airway remodeling group and 62 children with asthma who didn't present with airway remodeling were divided into non-airway remodeling group. 79 healthy children in the same period were selected as the control group. The lung function and airway remodeling indexes of all children in the two groups were tested and recorded. Enzyme-linked immunosorbent assay (ELISA) was applied to detect serum Sema7a and Activin A levels of all children. Pearson correlation analysis was applied to analyze relationships of serum Sema7a and Activin A levels with clinical data of asthmatic children with airway remodeling. Logistic regression was applied to analyze influencing factors of airway remodeling in children with asthma. Receiver operating characteristic (ROC) curve was applied to evaluate efficacy of serum Sema7a and Activin A levels for diagnosing airway remodeling of the children with asthma. Results The serum levels of Sema7a and Activin A of the children in the study group were significantly higher than those in the control group (t=15.648 and 17.357 respectively, both P<0.05). And the serum levels of Sema7a and Activin A of the children in the moderate or severe asthma groups were significantly higher than those in the mild asthma group, also, the serum levels of Sema7a and Activin A of the children in the severe asthma were significantly higher than those in the moderate asthma group (F=47.312 and 30.019 respectively, both P<0.05). Compared with the non-airway remodeling group, asthmatic children in the airway remodeling group had significantly increased airway wall thickness to airway lumen diameter ratio (T/D), airway wall area (WA) as a percentage of total airway area (WA%), serum Sema7a and Activin A levels, while in lung function indexes, they had significantly decreased peak expiratory flow (PEF) and forced expiratory volume to forced vital capacity ratio (FEV₁/FVC) (t=6.955, 4.142, 8.722, 7.327, 3.609 and 5.041 respectively, all P<0.05). Pearson correlation analysis showed that serum Sema7a level was positively correlated with serum Activin A level in asthmatic children in the airway remodeling group (r=0.516, P<0.05), the serum Sema7a level and the serum Activin A level were negatively correlated with PEF and FEV₁/FVC (r=-0.502, -0.469, -0.432 and -0.540 respectively, all P<0.05), and they were positively correlated with T/D and WA% (r=0.488, 0.354, 0.421 and 0.378 respectively, all P<0.05). Logistic regression analysis showed that PEF, FEV₁/FVC, T/D, WA%, Sema7a and Activin A were all influencing factors of airway remodeling in children with asthma (OR=0.667, 0.551, 1.492, 1.935, 1.589 and 2.367 respectively, all P<0.05). ROC analysis showed that areas under the curve (AUCs) of serum Sema7a and Activin A levels for diagnosing occurrence of airway remodeling in children with asthma were 0.861 and 0.833 respectively. The AUC of the combined diagnosis of the two indexes was 0.941, which was significantly higher than those of single serum Sema7a and single serum Activin A alone (Z_{combination-Sema7a}=2.028, P=0.043; Z_{combination-ActivinA}=2.568, P=0.010). Conclusion Serum Sema7a and Activin A levels greatly elevate in asthmatic children with airway remodeling, and they are correlated with lung function and airway remodeling indexes. The combined detection of the two indexes has good diagnostic efficacy for airway remodeling in children with asthma.

关键词

儿童 / 支气管哮喘 / 信号素7a / 激活素A / 气道重塑

Key words

children / bronchial asthma / semaphorin 7a / Activin A / airway remodeling

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