血清嗜酸性粒细胞趋化因子、肿瘤坏死因子-α、白细胞介素-17与儿童支气管哮喘预后的关系研究

Study on the relationship between serum eosinophil chemokine, tumor necrosis factor-α, interleukin-17, and prognosis in pediatric bronchial asthma

摘要:

目的 探讨血清嗜酸性粒细胞趋化因子（CCL11）、肿瘤坏死因子-α（TNF-α）、白细胞介素-17（IL-17）与儿童支气管哮喘预后的关系。方法 选取2020年8月—2022年8月在江苏大学附属医院儿科就诊的支气管哮喘患儿113例为观察组，另选取该院健康体检儿童50例为对照组；根据儿童哮喘控制测试（C-ACT）评分将观察组患儿分为预后不良组（C-ACT< 20分）30例和预后良好组（C-ACT≥ 20分）83例。比较观察组与对照组的血清CCL11、TNF-α和IL-17水平；比较预后不良组和预后良好组患儿血清CCL11、TNF-α和IL-17水平；采用Spearman法分析儿童支气管哮喘血清CCL11、TNF-α和IL-17水平与C-ACT评分的相关性；采用多因素一般Logistic回归模型分析儿童支气管哮喘预后不良的危险因素。绘制受试者工作特征（ROC）曲线评估血清CCL11、TNF-α和IL-17对儿童支气管哮喘预后的预测效能。结果 观察组患儿血清CCL11、TNF-α和IL-17水平均高于对照组（P <0.05）；预后良好组患儿血清CCL11、TNF-α和IL-17水平均低于预后不良组（P <0.05）。Spearman相关性分析显示，支气管哮喘患儿血清CCL11、TNF-α和IL-17水平与C-ACT评分呈负相关（P <0.05）。多因素一般Logistic回归分析结果显示，血清CCL1水平高［O^R =17.711（95% CI：1.882，166.646）］、TNF-α水平高［O^R =13.998（95% CI：1.305，150.111）］和IL-17水平高［O^R =36.576（95% CI：1.264，1 058.187）］均为儿童支气管哮喘预后不良的危险因素（P <0.05）。CCL11截断值为4.23 pg/mL时，预测儿童支气管哮喘预后不良的敏感性为93.3%（95% CI：0.768，0.983），特异性为90.4%（95% CI：0.819，0.957）；TNF-α截断值为0.99 μg/L时，预测儿童支气管哮喘预后不良的敏感性为90.0%（95% CI：0.735，0.979），特异性为84.3%（95% CI：0.747，0.914）；IL-17截断值为68.31 pg/mL时，预测儿童支气管哮喘预后不良的敏感性为93.3%（95% CI：0.768，0.983），特异性为90.4%（95% CI：0.819，0.957）；三者联合预测儿童支气管哮喘预后不良的敏感性为96.7%（95% CI：0.828，0.999），特异性为98.8%（95% CI：0.935，1.000）。结论 支气管哮喘患儿血清CCL11、TNF-α和IL-17水平较高，与C-ACT评分呈负相关；预后不良与CCL11、TNF-α和IL-17水平升高有关；CCL11、TNF-α和IL-17联合预测哮喘预后效能较高。

Abstract:

Objective To explore the relationship between serum levels of eosinophil chemotactic protein (Eotaxin, CCL11), TNF-α, interleukin 17 (IL-17), and prognosis in children with bronchial asthma.Methods A total of 113 children with bronchial asthma treated in the Department of Pediatrics at Jiangsu University Affiliated Hospital from August 2020 to August 2022 were selected as the observation group, and 50 healthy children undergoing physical examination were selected as the control group. According to the Childhood Asthma Control Test (C-ACT) scores, the children in observation group were divided into the group with poor prognosis 30 cases (C-ACT < 20 points) and the group with good prognosis 83 cases (C-ACT ≥ 20 points). Serum levels of CCL11, TNF-α, and IL-17 were compared between observation group and control group, as well as the group with good prognosis and the group with poor prognosis. The relationship between serum levels of CCL11, TNF-α, and IL-17 and the C-ACT scores were analyzed using Spearman's method. A multivariate logistic regression model was used to analyze the risk factors for poor prognosis in children with bronchial asthma. Receiver Operating Characteristic (ROC) curves were drawn to evaluate the predictive efficacy of serum CCL11, TNF-α, and IL-17 levels on the prognosis of children with bronchial asthma.Results In the observation group, the levels of serum CCL11, TNF-α, and IL-17 in children were higher than in the control group (P < 0.05); in the group with good prognosis, the levels of serum CCL11, TNF-α, and IL-17 were lower than in the group with poor prognosis (P < 0.05). Spearman correlation analysis showed that the levels of serum CCL11, TNF-α, and IL-17 in children with bronchial asthma were negatively correlated with the C-ACT score (P < 0.05). Multivariate general Logistic regression analysis results showed: high serum levels of CCL11 [O^R = 17.711 (95% CI: 1.882, 166.646)], TNF-α [O^R = 13.998 (95% CI: 1.305, 150.111)], and IL-17 [O^R = 36.576 (95% CI: 1.264, 1 058.187)] were risk factors for poor prognosis in children with bronchial asthma (P < 0.05). For the CCL11 level, with a cutoff value of 4.23 pg/mL, the sensitivity for predicting poor prognosis in children with bronchial asthma was 93.3% (95% CI: 0.768, 0.983), and the specificity was 90.4% (95% CI: 0.819, 0.957). For the TNF-α level, with a cutoff value of 0.99 μg/L, the sensitivity was 90.0% (95% CI: 0.735, 0.979), and the specificity was 84.3% (95% CI: 0.747, 0.914). For the IL-17 level, with a cutoff value of 68.31 pg/mL, the sensitivity was 93.3% (95% CI: 0.768, 0.983), and the specificity was 90.4% (95% CI: 0.819, 0.957). The combined sensitivity of the three predictors for poor prognosis in children with bronchial asthma is 96.7% (95% CI: 0.828, 0.999), and the specificity is 98.8% (95% CI: 0.935, 1.000).Conclusion The study shows that serum levels of CCL11, TNF-α, and IL-17 are higher in children with bronchial asthma and are negatively related to prognosis. Poor prognosis is associated with high levels of CCL11, TNF-α, and IL-17, and these indicators have high predictive efficacy for assessing asthma prognosis.