血清TLR4、TIMP-1水平与小儿热性惊厥临床特征的关系及对继发癫痫的预测价值  

Relationship between serum TLR4 and TIMP-1 levels with clinical characteristics of pediatric febrile convulsion and its predictive value for secondary epilepsy

作　　者：张润春[1] 李树华[1] 王玉珍[1] 张静[1] 曹志伟 ZHANG Runchun;LI Shuhua;WANG Yuzhen;ZHANG Jing;CAO Zhiwei(Department of Neurology,Tangshan Municipal Maternal and Child Health Care Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]河北省唐山市妇幼保健院神经内科,河北唐山063000

出　　处：《检验医学与临床》2024年第14期2089-2093,共5页Laboratory Medicine and Clinic

基　　金：河北省医学科学研究课题(20221747)。

摘　　要：目的分析血清Toll样受体4(TLR4)、基质金属蛋白酶组织抑制剂(TIMP)-1水平与小儿热性惊厥(FC)临床特征的关系及对FC继发癫痫的预测价值。方法选取2019年1月至2022年6月320例FC患儿作为研究组,另选取同期发热无惊厥儿童150例作为发热组,体检健康儿童150例作为对照组。根据FC患儿是否继发癫痫分为癫痫组和无癫痫组。采用酶联免疫吸附试验检测血清TLR4、TIMP-1水平,采用Pearson相关分析TLR4、TIMP-1水平及与临床指标间的相关性。采用受试者工作特征(ROC)曲线分析血清TLR4、TIMP-1预测FC继发癫痫的价值。采用Logistic回归分析FC患儿继发癫痫的影响因素。结果FC患儿、发热无惊厥儿童、体检健康儿童血清TLR4、TIMP-1水平依次降低,且两两比较,差异均有统计学意义(P<0.05)。研究组与发热组围生期异常发生情况、肿瘤坏死因子α(TNF-α)、C-反应蛋白(CRP)、白细胞介素-1β(IL-1β)水平和振幅整合脑电图(AEEG)评分比较,差异均有统计学意义(P<0.05)。癫痫组患儿血清TLR4、TIMP-1水平明显高于无癫痫组(P<0.05)。癫痫组和无癫痫组患儿首次惊厥次数、惊厥持续时间、首次惊厥前发热时间、围生期异常发生情况、TNF-α、CRP、IL-1β水平和AEEG评分比较,差异均有统计学意义(P<0.05)。血清TLR4水平与TIMP-1呈正相关(P<0.05);血清TLR4、TIMP-1水平与TNF-α、CRP、IL-1β呈正相关(P<0.05),与AEEG评分呈负相关(P<0.05)。TLR4、TIMP-1联合预测FC患儿继发癫痫的曲线下面积(AUC)明显高于单项检测的AUC(Z_(TLR4-联合)=3.016,P=0.003;Z_(TIMP-1-联合)=2.232,P=0.026)。Logistic回归分析结果表明,TLR4、TIMP-1、TNF-α、CRP、IL-1β水平升高,AEEG评分降低均为FC继发癫痫的危险因素(P<0.05)。结论血清TLR4、TIMP-1与FC患儿临床特征密切相关,TLR4、TIMP-1可能是FC继发癫痫的影响因素。Objective To analyze the relationship between the levels of serum Toll-like receptor 4(TLR4)and tissue inhibitor of matrix metalloproteinase 1(TIMP-1)with the clinical characteristics of febrile convulsion(FC)in children and its predictive value for secondary epilepsy.Methods A total of 320 children patients with FC from January 2019 to June 2022 were selected as the study group,other 150 children with fever and no convulsions during the same period were selected as the fever group,while 50 healthy children undergoing physical examination served as the control group.The FC children patients were divided into the epilepsy group and non-epilepsy group according to whether or not having secondary epilepsy.The enzyme linked immunosorbent assay was applied to detect serum TLR4 and TIMP-1 levels.The Pearson correlation was applied to analyze the correlation between the levels of TLR4 and TIMP-1 with the clinical indexes.The receiver operating characteristic(ROC)curve was applied to analyze the value of serum TLR4 and TIMP-1 in predicting FC secondary epilepsy.The Logistic regression was applied to analyze the influencing factors of secondary epilepsy in the children patients with FC.Results The serum TLR4 and TIMP-1 levels in children patients with FC,febrile children without convulsion and healthy children were in turn decreased,and pairwise comparison showed statistically significant differences(P<0.05).There were statistically significant differences in the perinatal abnormalities,TNF-α,CRP,IL-1βlevels and AEEG score between the study group and fever group(P<0.05).The serum TLR4 and TIMP-1 levels in the epilepsy group were significantly higher than those in the non-epilepsy group(P<0.05).There were statistically significant differences in the number of first convulsion,convulsion duration,fever duration before the first seizure,perinatal abnormalities,TNF-α,CRP,IL-1βlevels and AEEG scores between the epilepsy group and non-epilepsy group(P<0.05).There was a positive correlation between serum TLR4 level and TIMP-

关 键 词：TOLL样受体4 基质金属蛋白酶组织抑制剂1 小儿热性惊厥 癫痫 相关性 

分 类 号：R725.9[医药卫生—儿科] R446.11[医药卫生—临床医学]