外周血共刺激分子CD80、CD86表达与重症手足口病患儿治疗效果的关系  

Relationship between the expression of peripheral blood stimulating molecules CD80,CD86 and the therapeutic effects of children with severe hand,foot,and mouth disease

作　　者：周祥 蔡建新[2] 王飞 ZHOU Xiang;CAI Jian-xin;WANG Fei(Department of Clinical Laboratory,Wuhan Hospital of Traditional Chinese Medicine,Wuhan,Hubei 430000,China;Department of Pediatrics,Wuhan Hospital of Traditional Chinese Medicine,Wuhan,Hubei 430000,China;Department of Clinical Laboratory,Qingdao Central Hospital,Qingdao,Shandong 266200,China)

机构地区：[1]武汉市中医医院检验科,湖北武汉430000 [2]武汉市中医医院儿科,湖北武汉430000 [3]青岛市中心医院检验科,山东青岛266200

出　　处：《中国热带医学》2022年第12期1160-1164,1210,共6页China Tropical Medicine

基　　金：湖北省卫生健康委中医药科研项目(No.ZY2021Z008)。

摘　　要：目的观察重症手足口病(hand,foot,and mouth disease,HFMD)患儿外周血共刺激分子CD80、CD86的表达情况,并分析二者与患儿治疗效果的关系。方法回顾性收集2017年3月—2021年3月武汉市中医医院收治的252例重症HFMD患儿的临床资料,患儿均进行规范化治疗并评估治疗效果。记录患儿基线资料及实验室相关指标检测结果,采用流式细胞仪检测外周血CD80、CD86细胞阳性率。采用Logistic回归分析上述指标与患儿治疗效果的关系;绘制受试者工作特征曲线(receiver operating curve,ROC)评估上述指标预测患儿治疗效果的价值。结果经规范化治疗后,48例患儿治疗无效,204例患儿治疗有效;患儿血清CD80[(2.28±0.84)%vs(2.12±0.33)%]、CD86[(3.35±0.96)%vs(2.23±0.41)%]水平较入院时均下降,差异有统计学意义(t=2.851、16.991,P<0.05)。治疗无效组患儿入院时血乳酸、血清C反应蛋白(C-reactive protein,CRP)、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)、CD80、CD86水平均高于治疗有效组,差异有统计学意义(P<0.05)。Logistic回归分析显示,入院时血清CRP(OR=10.929)、MMP-9(OR=1.926)、CD80(OR=3.943)、CD86(OR=1.947)过表达可能是患儿治疗无效的风险因子(P<0.05);模型拟合优度检验结果显示,拟合优度较高(χ^(2)=6.245,P=0.620);模型共线性结果显示,各自变量的方差膨胀因子(variance inflation factors,VIF)值均<2,各主要指标之间不存在共线性;模型个体独立性检验结果显示,D-W=0.279,各主要指标之间相互独立性较差。ROC曲线分析显示:入院时血清CD80预测患儿治疗效果的曲线下面积(area under the curve,AUC)为0.762,cutoff值为2.390%,特异度、灵敏度、约登指数分别为0.598、0792、0.390;CD86预测的AUC为0.739,cut-off值为3.280%,特异度、灵敏度、约登指数分别为0.510、0.896、0.406;联合预测的AUC为0.823,特异度、灵敏度、约登指数分别为0.696、0.833、0.529。结论外周血共刺激分子CD80、CD8Objective To observe the expression of peripheral blood stimulating molecules CD80 and CD86 in children with severe hand,foot,and mouth disease(HFMD),and to analyze the relationship between them and the therapeutic effects of children.MethodsThe clinical data of 252 children with severe HFMD treated in Wuhan Hospital of Traditional Chinese Medicine from March 2017 to March 2021 were collected retrospectively.All children were treated with standardized treatment and the therapeutic effects was evaluated.The baseline data and laboratory test results of children were recorded,and the positive rates of CD80 and CD86 cells in peripheral blood were detected by flow cytometry.Logistic regression was used to analyze the relationship between the above indexes and the therapeutic effects of children.The receiver operating curve(ROC)was drawn to evaluate the value of the above indicators in predicting the therapeutic effects of children.ResultsAfter standardized treatment,48 children were ineffective,and 204 children were effective;the levels of serum CD80[(2.28±0.84)%vs(2.12±0.33)%]and CD86[(3.35±0.96)%vs(2.23±0.41)%]in children were significantly lower than those at admission(t=2.851,16.991;P<0.05).The levels of blood lactic acid,serum C-reactive protein(CRP),matrix metalloproteinase-9(MMP-9),CD80 and CD86 at admission in the ineffective group were significantly higher than those of the effective group(P<0.05).Logistic regression analysis showed that the overexpression of serum CRP(OR=10.929),MMP-9(OR=1.926),CD80(OR=3.943)and CD86(OR=1.947)at admission might be the risk factors of ineffective(all P<0.05).The results of the goodness of fit test for the model showed that,the goodness of fit was high(χ^(2)=6.245,P=0.620);the model collinearity results showed that the variance inflation factors(VIF)values of each variable were<2,and there was no collinearity among the main indicators;the results of the individual independence test for the model showed that Durbin-Watson statistics(D-W)=0.279 and there was poor mutual ind

关 键 词：重症手足口病 共刺激分子 CD80细胞 CD86细胞 治疗效果 

分 类 号：R511[医药卫生—内科学]