不同控制水平哮喘患儿血清25（OH）D3、CC16 水平和FeNO 的变化及临床意义*

Changes of serum 25(OH)D3, CC16, and FeNO levels in asthmatic children with different control levels and their clinical significance*

摘要:

目的 探讨不同控制水平哮喘患儿血清 25-羟维生素D3 ［25（OH）D3］、Clara 细胞分泌蛋白 16 （CC16）水平和呼出气一氧化氮（FeNO）的临床意义。方法 选取郑州大学附属儿童医院106例哮喘患儿为研究对象，依据哮喘控制水平分级标准分为良好控制组、部分控制组及未控制组。选取同期该院50例健康体检儿童为对照组。采用酶联免疫吸附试验（ELISA）检测各组儿童血清25（OH）D3、CC16、白细胞介素-4（IL-4）、血管内皮生长因子（VEGF）水平，并行FeNO测定，运用受试者工作特征（ROC）曲线评价血清25（OH）D3、CC16、IL-4、 VEGF及FeNO对哮喘未控制的诊断价值。结果 良好控制组、部分控制组及未控制组患儿血清25（OH）D3、 CC16水平低于对照组（P <0.05），未控制组低于部分控制组及良好控制组（P <0.05）；良好控制组、部分控制组及未控制组患儿血清IL-4、VEGF水平和FeNO值高于对照组（P <0.05），未控制组高于部分控制组及良好控制组（P <0.05）；血清25（OH）D3与CC16呈正相关（P <0.05），与IL-4、VEGF及FeNO呈负相关（P <0.05）；ROC曲线结果显示血清25（OH）D3、CC16诊断哮喘未控制的曲线下面积分别为0.902［（95%CI：0.809，0.966），P =0.001］和0.764［（95% CI：0.621，0.907），P =0.003］，截断值分别为18.523 ng/ml、10.741 μg/L，特异性分别为 83.6%和76.4%，敏感性分别为89.2%和82.7%。结论 哮喘患儿血清25（OH）D3、CC16与哮喘控制水平相关，检测哮喘患儿血清25（OH）D3及CC16水平，同时动态监测FeNO，对评估哮喘控制水平及调整治疗方案具有指导意义。

Abstract:

Objective To explore the serum vitamin D3 [25(OH)D3] levels, Clara cell secretory protein 16 (CC16) levels, and fractional exhaled nitric oxide (FeNO) in asthmatic children with different control levels and its clinical significance. Methods A total of 106 children with asthma were included in the study. According to the classification criteria of asthma control level, it is divided into good control group, partial control group, and uncontrolled group, The control group was 50 healthy children with physical examination during the same period. Serum levels of 25(OH)D3, CC16, IL-4 and VEGF were measured by ELISA, and fractional exhaled nitric oxide (FeNO) was detected. ROC curve was used to evaluate the diagnostic value of 25(OH)D3, CC16, IL-4, VEGF, and FeNO for asthma uncontrolled level. Results The serum levels of 25(OH)D3 and CC16 in asthmatic children were significantly lower than those in the control group, and the uncontrolled group was lower than the control group and the good control group. The serum levels of IL-4 and VEGF in asthmatic children were higher than those in the control group, and uncontrolled group was higher than partial control group and good control group. The level of FeNO in children with asthma was higher than that in the control group, and the uncontrolled group was higher than the part of the control group and the good control group. Serum 25(OH)D3 concentration was positively correlated with CC16 and negatively correlated with IL-4, VEGF, and FeNO levels. The ROC curve analysis showed that the area under the curve of serum 25(OH)D3 and CC16 for the diagnosis of uncontrolled asthma were 0.902 and 0.76. The critical values were 18.523 ng/ml and 10.741 ug/L, the specificities were 83.614% and 76.422% (95% CI: 0.809 and 0.966, P = 0.001), and the sensitivities were 89.214% and 82.725% (95% CI: 0.621 and 0.907, P = 0.003). Conclusion Serum 25(OH)D3 and CC16 in asthmatic children are closely related to asthma control level. Detection of serum 25(OH)D3 and CC16 levels in children with asthma and dynamic monitoring of FeNO are useful for assessing asthma control levels and adjusting treatment options.