血清嗜酸性粒细胞阳离子蛋白与白三烯B4联合预测支气管哮喘患儿预后的临床价值

Clinical value of serum eosinophil cationic protein and leukotriene B4 in predicting the prognosis of children with bronchial asthma

摘要:

目的 探究血清嗜酸性粒细胞阳离子蛋白（ECP）与白三烯B4（LTB4）联合预测支气管哮喘患儿预后的临床价值。方法 选取2020年12月—2022年12月江南大学附属儿童医院收治的支气管哮喘患儿80例作为研究对象。给予患儿对症治疗，治疗28 d后，依据肺功能指标改善状况及儿童哮喘控制测试（C-ACT）结果将患儿分为病情控制良好组和控制不佳组。检测两组患儿入院时血清ECP、LTB4水平；采用多因素逐步Logistic回归模型分析影响患儿支气管哮喘病情控制的危险因素；绘制受试者工作特征（ROC）曲线评估血清ECP、LTB4对支气管哮喘患儿预后的预测效能。结果 80例支气管哮喘患儿中控制不佳17例，63例患儿病情控制良好且未见复发。控制不佳组过敏史、呼吸道反复感染史占比及血清ECP、LTB4水平均高于控制良好组（P <0.05）。过敏史［O^R =3.557（95% CI：1.053，12.023）］、呼吸道反复感染史［O^R =4.923（95% CI：1.289，18.806）］、血清ECP水平升高［O^R =3.770（95% CI：1.115，12.741）］、血清LTB4水平升高［O^R =4.212（95% CI：1.246，14.236）］均是患儿支气管哮喘病情控制不佳的危险因素（P <0.05）。血清ECP、LTB4单一及联合预测支气管哮喘患儿预后的敏感性分别为73.6%（95% CI：0.619，0.842）、77.1%（95% CI：0.625，0.891）、88.5%（95% CI：0.703，0.951），特异性分别为80.3%（95% CI：0.724，0.875）、66.9%（95% CI：0.603，0.749）、76.4%（95% CI：0.631，0.872），AUC分别为0.786（95% CI：0.690，0.881）、0.743（95% CI：0.644，0.843）、0.834（95% CI：0.747，0.921）。结论 血清ECP、LTB4与支气管哮喘患儿的预后有关，血清ECP、LTB4单一及联合预测支气管哮喘患儿预后的效能良好。

Abstract:

Objective To investigate the clinical value of combined serum eosinophil cationic protein (ECP) and leukotriene B4 (LTB4) in predicting the prognosis of pediatric asthma.Methods Eighty cases of pediatric asthma admitted to the Children's Hospital affiliated with Jiangnan University from December 2020 to December 2022 were selected for the study. Symptomatic treatment was given to the children, and after 28 days of treatment, the patients were divided into a well-controlled group and a poorly controlled group based on the improvement of pulmonary function indicators and the results of the Childhood Asthma Control Test (C-ACT). The serum levels of ECP and LTB4 were detected in both groups upon admission. A multifactorial Logistic stepwise regression model was used to analyze the risk factors affecting the disease control of pediatric asthma. Receiver Operating Characteristic (ROC) curves were drawn to evaluate the predictive efficacy of serum ECP and LTB4 for the prognosis of pediatric asthma.Results Among the 80 pediatric asthma patients, 17 had poor control, while 63 had well-controlled conditions without relapse. The poorly controlled group had a higher proportion of allergic history, a history of recurrent respiratory infections, and higher levels of serum ECP and LTB4 than the well-controlled group (P < 0.05). Allergic history [O^R = 3.557 (95% CI: 1.053, 12.023) ], a history of recurrent respiratory infections [O^R = 4.923 (95% CI: 1.289, 18.806) ], elevated serum ECP levels [O^R = 3.770 (95% CI: 1.115, 12.741) ], and elevated serum LTB4 levels [O^R = 4.212 (95% CI: 1.246, 14.236) ] were all risk factors for poor disease control in pediatric asthma (P < 0.05). The sensitivity of serum ECP, LTB4, and their combination in predicting the prognosis of pediatric asthma was 73.6% (95% CI: 0.619, 0.842), 77.1% (95% CI: 0.625, 0.891), and 88.5% (95% CI: 0.703, 0.951), respectively. The specificity was 80.3% (95% CI: 0.724, 0.875), 66.9% (95% CI: 0.603, 0.749), and 76.4% (95% CI: 0.631, 0.872), respectively. The AUC was 0.786 (95% CI: 0.690, 0.881), 0.743 (95% CI: 0.644, 0.843), and 0.834 (95% CI: 0.747, 0.921), respectively.Conclusion Serum ECP and LTB4 are related to the prognosis of pediatric asthma. The predictive efficacy of serum ECP and LTB4, either alone or in combination, is good for predicting the prognosis of pediatric asthma.