血清DcR3、PD-L1水平与支气管哮喘儿童肺功能的相关性及其诊断价值

The correlation of serum levels of DcR3 and PD-L1 with lung function and their diagnostic values in children with bronchial asthma

摘要:

目的 探究血清诱骗受体3（DcR3）、程序性死亡配体-1（PD-L1）水平与支气管哮喘儿童肺功能的相关性及其诊断价值。方法 选取2019年9月—2022年9月上饶市人民医院收治的150例支气管哮喘患儿作为研究对象，根据病情分为急性发作组和慢性持续组，分别有90和60例，选取同期在该院体检的150例健康儿童为对照组。比较3组血清DcR3、PD-L1水平和肺功能指标。Pearson法分析支气管哮喘儿童血清DcR3、PD-L1水平与肺功能指标的相关性。受试者工作特征（ROC）曲线分析血清DcR3、PD-L1对支气管哮喘急性发作的诊断价值。结果 各组性别构成、年龄和BMI比较，差异均无统计学意义（P >0.05）。慢性持续组、急性发作组免疫球蛋白E、DcR3、PD-L1水平高于对照组，急性发作组高于慢性持续组（P <0.05）。慢性持续组、急性发作组第1秒用力呼吸容积占预计值（FEV₁）、FEV₁/第1秒用力呼吸容积用力肺活量百分比（FVC）、最大呼气峰流速（PEF）水平低于对照组，急性发作组低于慢性持续组（P <0.05）。Pearson结果显示，FEV₁与血清DcR3、PD-L1水平呈负相关性（r =-0.452和-0.489，均P <0.05）；FEV₁/FVC₁与血清DcR3、PD-L1水平呈负相关性（r =-0.447和-0.501，均P <0.05），PEF与血清DcR3、PD-L1水平呈负相关性（r =-0.529和-0.497，均P <0.05）。ROC曲线分析结果显示，DcR3、PD-L1的最佳截断值分别为7.48 ng/mL、87.90 pg/mL，DcR3、PD-L1单独及联合辅助诊断儿童是否发生支气管哮喘急性发作的曲线下面积分别为0.789（95% CI：0.713，0.866）、0.776（95% CI：0.701，0.851）、0.879（95% CI：0.823，0.934），敏感性分别为72.20%（95% CI：0.618，0.811）、71.10%（95% CI：0.606，0.802）、83.30%（95% CI：0.740，0.904），特异性分别为66.70%（95% CI：0.533，0.783）、66.70%（95% CI：0.533，0.783）、78.30%（95% CI：0.658，0.879）。结论 哮喘患儿血清DcR3、PD-L1水平升高，且两者与肺功能指标相关，对评估支气管哮喘急性发作有较好的诊断价值。

Abstract:

Objective To investigate the correlation of serum levels of decoy receptor 3 (DcR3) and programmed death ligand 1 (PD-L1) with lung function and their diagnostic values in children with bronchial asthma.Methods A total of 150 children with bronchial asthma admitted to our hospital from September 2019 to September 2022 were selected and divided into the acute attack group (n = 90) and chronic persistent group (n = 60) based on the disease condition. Another 150 healthy children who underwent health checkup in our hospital during the same period were selected as the control group. The serum levels of DcR3 and PD-L1 as well as the parameters associated with the lung function were compared among the three groups. Pearson method was applied to analyze the relationship between serum levels of DcR3 and PD-L1 and parameters associated with the lung function in children with bronchial asthma. The receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of serum DcR3 and PD-L1 for acute attack of bronchial asthma.Results There was no difference in the sex composition, age, and body mass index (BMI) among the groups (P > 0.05). The levels of immunoglobin E (IgE), DcR3 and PD-L1 in the chronic persistent group and the acute attack group were higher than those in the control group, and they were even higher in the acute attack group than those in the chronic persistent group (P < 0.05). The forced expiratory volume in one second (FEV1), FEV1/forced vital capacity (FVC), and peak expiratory flow (PEF) in the chronic persistent group and the acute attack group were lower than those in the control group (P < 0.05), and they were even lower in the acute attack group than those in the chronic persistent group (P < 0.05). The Pearson correlation analysis showed that FEV₁ was negatively correlated with serum levels of DcR3 and PD-L1 (r = -0.452 and -0.489, both P < 0.05), FEV₁/FVC was negatively correlated with serum levels of DcR3 and PD-L1 (r = -0.447 and -0.501, both P < 0.05), and that PEF was negatively correlated with serum levels of DcR3 and PD-L1 (r = -0.529 and -0.497, both P < 0.05). The ROC curve analysis revealed that the optimal cut-off values of DcR3 and PD-L1 were 7.48 ng/mL and 87.90 pg/mL, and the areas under the ROC curves (AUCs) of DcR3, PD-L1 alone and their combination in the diagnosis of acute attack of bronchial asthma in children were 0.789 (95% CI: 0.713, 0.866), 0.776 (95% CI: 0.701, 0.851), and 0.879 (95% CI: 0.823, 0.934), with the sensitivities being 72.20% (95% CI: 0.618, 0.811), 71.10% (95% CI: 0.606, 0.802), and 83.30% (95% CI: 0.740, 0.904), and the specificities being 66.70% (95% CI: 0.533, 0.783), 66.70% (95% CI: 0.533, 0.783) and 78.30% (95% CI: 0.658, 0.879), respectively.Conclusions The serum levels of DcR3 and PD-L1 are elevated in children with bronchial asthma, and they are correlated with parameters associated with the lung function, exhibiting a great value for evaluating acute attacks of bronchial asthma.