外周血CTLA4、TIM3对重症肺炎合并呼吸衰竭患儿疾病转归的预测价值  

Prognostic value of CTLA4 and TIM3 in peripheral blood of children with severe pneumonia complicated with respiratory failure

作　　者：郝剑[1] 贺杰[1] 马俊帅[1] 张斌[1] 温翠玲[2] HAO Jian;HE Jie;MA Junshuai;ZHANG Bin;WEN Cuiling(Department of Clinical Laboratory(Emergensy),the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院检验科(急诊),河北张家口075000 [2]河北北方学院附属第一医院呼吸与危重症医学科,河北张家口075000

出　　处：《国际检验医学杂志》2023年第22期2706-2709,2715,共5页International Journal of Laboratory Medicine

基　　金：河北省2023年度医学科学研究课题(20231430)。

摘　　要：目的探讨外周血细胞毒性T淋巴细胞相关抗原(CTLA4)、T细胞免疫球蛋白黏蛋白分子3(TIM3)对重症肺炎合并呼吸衰竭患儿疾病转归的预测价值。方法选取2021年5月至2022年8月该院收治的108例重症肺炎合并呼吸衰竭患儿作为研究组。另选取同期来该院体检的120例健康儿童作为健康组。根据研究组30 d转归情况不同分为存活组(n=77)和死亡组(n=31)两个亚组。采用流式细胞仪检测外周血T细胞上CTLA4、TIM3表达水平。采用受试者工作特征(ROC)曲线评估CTLA4、TIM3对重症肺炎合并呼吸衰竭患儿预后的评估价值,多因素Logistic回归分析探讨重症肺炎合并呼吸衰竭患儿死亡的影响因素。结果研究组外周血T细胞上CTLA4、TIM3水平高于健康组,差异有统计学意义(P<0.05)。死亡组外周血T细胞上CTLA4、TIM3水平高于存活组,差异有统计学意义(P<0.05)。血清CTLA4、TIM3预测重症肺炎合并呼吸衰竭患儿预后的曲线下面积(95%CI)分别为0.779(95%CI:0.728~0.828)、0.842(95%CI:0.791~0.893),最佳截断值分别为9.67%、49.22%,特异度分别为57.14%、62.34%,灵敏度分别为90.32%、90.32%,二者联合检测的曲线下面积(95%CI)为0.929(0.888~0.970),特异度为85.71%,灵敏度为87.10%。存活组年龄、出生体质量、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、合并低氧血症、合并高碳酸血症、白细胞计数(WBC)、C反应蛋白(CRP)与死亡组比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,APACHEⅡ评分≥18分(OR=2.143,95%CI:1.503~3.055)、CTLA4≥9.67%(OR=2.497,95%CI:1.658~3.761)、TIM3≥49.22%(OR=3.025,95%CI:1.943~4.711)是重症肺炎合并呼吸衰竭患儿死亡的危险因素(P<0.05)。结论重症肺炎合并呼吸衰竭患儿外周血T细胞上CTLA4、TIM3水平明显升高,且与疾病转归密切相关,有望作为评估患儿病情变化的生物学指标。Objective To explore the predictive value of peripheral blood cytotoxic T lymphocyt-associated antigen(CTLA4)and T cell immunoglobulin mucin molecule 3(TIM3)in the prognosis of severe pneumonia complicated with respiratory failure.Methods A total of 108 children with severe pneumonia combined with respiratory failure admitted to a hospital from May 2021 to August 2022 were selected as the study group.In addition,120 healthy children who came to a hospital for physical examination during the same period were selected as the healthy group.The study group was divided into two subgroups,survival group(n=77)and death group(n=31),according to different 30 d outcomes.The expression levels of CTLA4 and TIM3 in peripheral blood T cells were detected by flow cytometry.ROC was used to evaluate the prognostic value of CTLA4 and TIM3 in children with severe pneumonia complicated with respiratory failure.The influencing factors of death in children with severe pneumonia complicated with respiratory failure were explored by multivariate Logistic regression.Results The levels of CTLA4 and TIM3 on peripheral blood T cells in the study group were higher than those in the healthy group,and the difference was statistically significant(P<0.05).CTLA4 and TIM3 levels in peripheral blood T cells in death group were higher than those in survival group,and the difference was statistically significant(P<0.05).The area under the curve of serum CTLA4 and TIM3 for predicting the prognosis of severe pneumonia with respiratory failure were 0.779(95%CI:0.728-0.828)and 0.842(0.791-0.893),respectively.The cut-off values were 9.67%and 49.22%,and the specificities were 57.14%and 62.34%,respectively.The sensitivity was 90.32%and 90.32%,respectively.The area under the curve,specificity and sensitivity were 0.929(95%CI:0.888-0.970),85.71%and 87.10%,respectively.There were significant differences in age,birth weight,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,hypoxemia,hypercapnia,white blood cell(WBC)and C-reaction protein(CRP)bet

关 键 词：细胞毒性T淋巴细胞相关抗原 T细胞免疫球蛋白黏蛋白分子3 重症肺炎 呼吸衰竭 预后 

分 类 号：R725.6[医药卫生—儿科]