肿瘤坏死因子相关激活蛋白、CD4^(+)/CD8^(+)、IL-4与儿童细菌性社区获得性肺炎经典炎症标志物的关系研究  

Relationship between CD40L,CD4^(+)/CD8^(+),IL-4 and the classic inflammation biomarkers for bacterial pediatric community acquired pneumonia and the predictive performance in antibacterial therapy

作　　者：黄光举[1] 张慧玉[1] 李娟[1] 李佳[1] 徐静 HUANG Guang-ju;ZHANG Hui-yu;LI Juan;LI Jia;XU Jing(Department of Pediatric Internal Medicine,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,China)

机构地区：[1]河北省唐山市妇幼保健院儿内科,063000

出　　处：《蚌埠医学院学报》2022年第4期482-486,490,共6页Journal of Bengbu Medical College

基　　金：河北省科技计划项目(20181334)。

摘　　要：目的:探讨肿瘤坏死因子相关激活蛋白(CD40L)、CD4^(+)/CD8^(+)、白细胞介素-4(IL-4)与儿童细菌性社区获得性肺炎(CAP)经典炎症标志物的关系及预测抗菌治疗效果的效能。方法:选取300例儿童细菌性CAP患儿,均给予化痰、止咳、平喘及抗感染治疗,其中43例治疗无效(观察组)及257例治疗有效(对照组),比较2组治疗前白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)及CD40L、CD4^(+)/CD8^(+)、IL-4,采用Pearson分析CD40L、CD4^(+)/CD8^(+)、IL-4与经典炎症标志物的关系及CD40L、CD4^(+)/CD8^(+)、IL-4之间的关系,采用logistic回归方程分析CD40L、CD4^(+)/CD8^(+)、IL-4与治疗无效的关系,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析CD40L、CD4^(+)/CD8^(+)、IL-4预测抗菌治疗效果的效能。结果:观察组WBC、CRP、PCT、CD40L、IL-4水平均高于对照组(P<0.01),CD4^(+)/CD8^(+)低于对照组(P<0.01);CD40L与WBC、CRP、PCT均呈正相关(r=0.720、0.433、0.832,P<0.01),CD4^(+)/CD8^(+)与WBC、CRP、PCT呈负相关(r=-0.709、-0.449、-0.698,P<0.01),IL-4与WBC、CRP、PCT呈正相关(r=0.889、0.760、0.723,P<0.01);CD40L、CD4^(+)/CD8^(+)、IL-4均与治疗无效的相关性具有统计学意义(P<0.01);CD40L与CD4^(+)/CD8^(+)呈负相关(r=-0.776,P<0.01),与IL-4呈正相关(r=0.554,P<0.01);CD4^(+)/CD8^(+)与IL-4呈负相关(r=-0.538,P<0.01);单一指标中IL-4预测抗菌治疗效果的AUC最大为0.805,各指标联合预测抗菌治疗效果的AUC为0.867,敏感度达79.07%,大于任一单一指标(P<0.01)。结论:CD40L、IL-4、CD4^(+)/CD8^(+)与经典炎症标志物存在一定相关性,可在一定程度上反映细菌性CAP患儿病情程度,治疗期间进行动态监测可及早预测疗效,为细菌性CAP患儿后续治疗提供参考依据。Objective:To investigate the relationship between tumor necrosis factor-related activator protein(CD40L),CD4^(+)/CD8^(+),interleukin-4(IL-4)and classic inflammatory biomarkers of bacterial pediatric community acquired pneumonia(CAP)and the predictive efficacy in antibacterial therapy.Methods:A total of 300 children with bacterial CAP were selected for treatment of phlegm removing,cough relieving,asthma reducing and anti-infection.The non-response cases were set as observation group(n=43)and the improved cases were set as control group(n=257).The white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),CD40L,CD4^(+)/CD8^(+)and IL-4 were detected before treatment.Pearson correlation analysis was used to analyze the relationship between CD40L,CD4^(+)/CD8^(+),IL-4 and classic inflammation markers and the relationship between CD40L,CD4^(+)/CD8^(+),IL-4.The logistic regression equation was used to analyze the relationship between CD40L,CD4^(+)/CD8^(+),IL-4 and non-response treatment.The receiver operating characteristic(ROC)curve and the area under the ROC cure(AUC)were used to analyze the predictive efficacy of CD40L,CD4^(+)/CD8^(+)and IL-4 of antibacterial treatment.Results:WBC,CRP,PCT,CD40L and IL-4 in the observation group were higher than those in the control group(P<0.01)and CD4^(+)/CD8^(+)was lower than that in the control group(P<0.01).CD40L was positively correlated with WBC,CRP and PCT(r=0.720,0.433,0.832,P<0.01),CD4^(+)/CD8^(+)was negatively correlated with WBC,CRP and PCT(r=-0.709,-0.449,-0.698,P<0.01),IL-4 was positively correlated with WBC,CRP and PCT(r=0.889,0.760,0.723,P<0.01).CD40L,CD4^(+)/CD8^(+),IL-4 were all significantly correlated with treatment failure(P<0.01).CD40L was negatively correlated with CD4^(+)/CD8^(+),and positively correlated with IL-4(r=-0.776,0.554,P<0.01).CD4^(+)/CD8^(+)was negatively correlated with IL-4(r=-0.538,P<0.01).Among the single indicators,the maximum AUC of IL-4 predicting the effect of antibacterial treatment was 0.805,the AUC of each indicator combined to

关 键 词：社区获得性肺炎 肿瘤坏死因子相关激活蛋白 白细胞介素-4 炎症标志物 

分 类 号：R563.1[医药卫生—呼吸系统]